Provider Demographics
NPI:1477249126
Name:MORENO, JAIME MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:MIGUEL
Last Name:MORENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GIRASOL Y FRESNOS
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:CUENCA
Mailing Address - State:AZUAY
Mailing Address - Zip Code:010150
Mailing Address - Country:EC
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DANIEL CORDOVA Y FEDERICO PROANO
Practice Address - Street 2:OFFICE 003
Practice Address - City:CUENCA
Practice Address - State:AZUAY
Practice Address - Zip Code:010150
Practice Address - Country:EC
Practice Address - Phone:593-997-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC312449207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine