Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC16645 | CA |
N | 111NS0005X | Chiropractic Sports Physician | DC16645 | CA |
NPI | 1255544607 |
---|---|
Provider Name | Robert David Moreno |
First Address | Palo Alto, CA 94301-2827 |
Second Address | Palo Alto, CA 94301-2827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 21/04/2016 |