Basic Information
| Provider Information | |||||||||
| NPI: | 1982225512 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORON | ||||||||
| FirstName: | CHERONNA | ||||||||
| MiddleName: | SHAUNTE' | ||||||||
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| Mailing Information | |||||||||
| Address1: | 213 1/2 E 84TH PL | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900033027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2672709018 | ||||||||
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| Practice Location | |||||||||
| Address1: | 503 OCEAN FRONT WALK | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902912403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103923070 | ||||||||
| FaxNumber: | 3103920823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2020 | ||||||||
| LastUpdateDate: | 05/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN212640 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.