Provider Demographics
NPI:1013286178
Name:MORENO, HEIDI LOURDEZ
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:LOURDEZ
Last Name:MORENO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3745 OVERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6311
Mailing Address - Country:US
Mailing Address - Phone:310-392-5855
Mailing Address - Fax:
Practice Address - Street 1:3745 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6311
Practice Address - Country:US
Practice Address - Phone:310-392-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373H00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)