Provider Demographics
NPI:1467099184
Name:MORENO, ROSA MARIA
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:MARIA
Last Name:MORENO
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 1:13745 PASEO DE VIDA DR
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-8429
Mailing Address - Country:US
Mailing Address - Phone:915-355-9297
Mailing Address - Fax:
Practice Address - Street 1:13745 PASEO DE VIDA DR
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-8429
Practice Address - Country:US
Practice Address - Phone:915-355-9297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-01
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion