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Elisa Amelia Moreno

Psychiatry & Neurology

Allopathic & Osteopathic Physicians

1520 San Pablo St Ste 1652, Los Angeles, CA 90033-5310

PECOS Enrollment

This provider is enrolled in PECOS as ELISA MORENO.

Based on the most recent information from CMS, provider Elisa Amelia Moreno is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1447447172
Provider Type
Individual
Full Name
Moreno, Elisa Amelia
Credential
MD (MBBS)

Gender
Female
Sole Proprietor
No
Enumeration Date
9/26/2007
Last Updated
7/30/2021

Contact Information

Practice Location

1520 San Pablo St Ste 1652, Los Angeles, CA 90033-5310

(323) 442-6000

Unlisted Fax

Mailing Location

PO Box 31309, Los Angeles, CA 90031-0309

(323) 442-5100

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2084P0800X Primary	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License A96429 California

Provider Identifiers

ID	Description	Issuer
ID 00A964290	Description Medicaid	Issuer Unlisted California

Elisa Amelia Moreno

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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