Provider Demographics
NPI:1508444183
Name:MORENO, RUBY
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:
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 1:550 16TH STREET
Mailing Address - Street 2:4TH FLOOR, 4551, BOX 0110
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143
Mailing Address - Country:US
Mailing Address - Phone:415-502-2362
Mailing Address - Fax:415-476-5354
Practice Address - Street 1:550 16TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2549
Practice Address - Country:US
Practice Address - Phone:415-502-2362
Practice Address - Fax:415-476-5354
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program