Timothy R. Moreno, MD, Inc

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

A45369 Issued in CA

Legal business name

TIMOTHY R. MORENO, MD, INC

Doing business as

Moreno Urology

Practice address

105 S Forest Rd
Sonora, CA 95370-4895

Phone

(209) 532-1255

Fax

(209) 532-8436

NPI assigned

Mar 6, 2017

Last updated

Mar 6, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Timothy R Moreno, M.D.

Title

President

Phone

(209) 840-2575

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Moreno Urology Doing business as

Locations

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

{
    "created_epoch": "1488758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488758400000",
    "number": "1649710971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S FOREST RD",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953704895",
            "telephone_number": "209-532-1255",
            "fax_number": "209-532-8436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S FOREST RD",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953704895",
            "telephone_number": "209-532-1255",
            "fax_number": "209-532-8436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY R. MORENO, MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-06",
        "last_updated": "2017-03-06",
        "status": "A",
        "authorized_official_last_name": "MORENO",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-840-2575",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CA",
            "license": "A45369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A453690",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moreno Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Medical Specialty Clinic/Center in Sonora, CA
• Providers in Sonora, CA by specialty
• Medical Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2017; 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.