Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 57434 | CA |
NPI | 1003381583 |
---|---|
Provider Name | Edgar Moreno |
First Address | Arvin, CA 93203-2000 |
Second Address | Bakersfield, CA 93309-0679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2018 |
Last Update Date | 28/10/2019 |