Alexander Jake Alfonso Moreno, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

64065 Issued in CA

Practice address

101 Raley Blvd Ste 202
Chico, CA 95928-8352

Phone

(530) 592-4688

NPI assigned

Jan 16, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 21, 2016 through Mar 21, 2028

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1144619982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 RALEY BLVD STE 202",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959288352",
            "telephone_number": "530-592-4688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 RALEY BLVD STE 202",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959288352",
            "telephone_number": "530-592-4688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO",
        "first_name": "ALEXANDER JAKE",
        "middle_name": "ALFONSO",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-16",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "64065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Omar Mora-Perez, MSW, ASW
• Marisol Mojica Morales, BA
• Rebecca Joanne Moralez
• Audra Monroe Moran
• Daniela Morcos-Gannon, M.D.
• Casey McConnell Moreno
• Laura P Moreno, RN
• Mauro Moreno, PAC
• Morgan Szymczak Marriage and Family Therapy
• Bryce William Morgan, LVN

• General Practice Dentistry in Chico, CA
• Providers in Chico, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.