Provider Demographics
NPI:1144773599
Name:MORENO, JAZMIN (QMHP)
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10501 GATEWAY BLVD W BLDG 13
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7929
Mailing Address - Country:US
Mailing Address - Phone:915-544-3500
Mailing Address - Fax:
Practice Address - Street 1:10501 GATEWAY BLVD W BLDG 13
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7929
Practice Address - Country:US
Practice Address - Phone:915-544-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator