Amanda Moreno, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

31063 Issued in CA

Practice address

California Mens Colony
Highway 1
San Luis Obispo, CA 93409-0001

Phone

(805) 547-7900

NPI assigned

Dec 30, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1451433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1336504687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "253 10TH AVE",
            "address_2": "UNIT 624",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921017453",
            "telephone_number": "619-417-4779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALIFORNIA MENS COLONY",
            "address_2": "HIGHWAY 1",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934090001",
            "telephone_number": "805-547-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO",
        "first_name": "AMANDA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-30",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "31063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan K Moon Labriola, NP
• Rebekah Alexander Mora, LCSW
• Yesenia Hernandez Mora
• Jonas Morales, NP
• Daniel Robert More, M.D.
• Cassidy Emi Adams Moreno, M.A., BCBA
• Joseph Kelly Moreno, PH.D.
• Lisa Kathleen Moreno, OTR/L, CHT, PAMS
• Samuel Joseph Moreno
• Sandra Ann Moreno

• Psychologist in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.