Active NPI
Mary Moreno, HOME CARE AIDE
- Personal Care Attendant
- San Diego, CA
National Provider Identifier
1760037147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Personal Care Attendant
- License
- 7517414402
- Practice address
- 225 Redwood St Apt 23
San Diego, CA 92103-5668 - Phone
- (619) 643-5334
- NPI assigned
- Aug 2, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | 7517414402 | CA | Primary |
Addresses
Primary practice location
225 Redwood St Apt 23
San Diego, CA 92103-5668
Mailing address
PO Box 80906
San Diego, CA 92138-0906
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7517414402 | Other | CA | DEPT OF SOCIAL SERVICES HOME CARE SERVICES BUREAU |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7517414402 | CA | MD | Personal Care Attendant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564704000000",
"number": "1760037147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 80906",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921380906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 REDWOOD ST APT 23",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921035668",
"telephone_number": "619-643-5334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "MARY",
"credential": "HOME CARE AIDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-02",
"last_updated": "2019-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "3747P1801X",
"taxonomy_group": "",
"desc": "Technician, Personal Care Attendant",
"state": "CA",
"license": "7517414402",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF SOCIAL SERVICES HOME CARE SERVICES BUREAU",
"identifier": "7517414402",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.