Blake Michael Moreno

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

115717 Issued in CA

Practice address

17831 Autry CT
Chino Hills, CA 91709-3281

Phone

(951) 444-5140

NPI assigned

Aug 19, 2013

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• McKinley Children'S Center

  • Community/Behavioral Health Agency
  • Riverside, CA
  • NPI 1831691880
  NPD (past)

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

{
    "created_epoch": "1376870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1174956650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "762 CYPRESS ST",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733505",
            "telephone_number": "909-573-9748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17831 AUTRY CT",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917093281",
            "telephone_number": "951-444-5140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6700 Indiana Ave Ste 280",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925064265",
            "country_code": "US",
            "telephone_number": "909-444-5140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORENO",
        "first_name": "BLAKE",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-19",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "115717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Naheed Momand, D.O.
• Daryl C Moniaga, OD
• Reese Ann Montgomery
• Debra Alice Montoya
• Larry J. Moore, D.D.S., M.S.
• Dyann Mireya Moreno
• Bahar Movahed Bashiri, DDS, MS
• Tomasa Muniz
• Bryce Munyer
• Matthew Rikio Murayama, DO

• Clinical Social Worker in Chino Hills, CA
• Providers in Chino Hills, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.