Provider Demographics
NPI:1225733801
Name:MORENO DE GRIESE, LOURDES MARIA
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:MARIA
Last Name:MORENO DE GRIESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 LORAWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7405
Mailing Address - Country:US
Mailing Address - Phone:714-813-5296
Mailing Address - Fax:
Practice Address - Street 1:1300 LORAWOOD ST
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7405
Practice Address - Country:US
Practice Address - Phone:714-813-5296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA701133163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse