Provider Demographics
NPI:1366508616
Name:MORENO, JOHN N (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:N
Last Name:MORENO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:213 S RYAN STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5974
Mailing Address - Country:US
Mailing Address - Phone:337-436-4007
Mailing Address - Fax:337-436-4561
Practice Address - Street 1:213 S RYAN STREET
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5974
Practice Address - Country:US
Practice Address - Phone:337-436-4007
Practice Address - Fax:337-436-4561
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath