Provider Demographics
NPI:1568166080
Name:MORENO, ANMARIE (ATC)
Entity Type:Individual
Prefix:
First Name:ANMARIE
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 ALTON PKWY APT 439
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-3158
Mailing Address - Country:US
Mailing Address - Phone:310-505-7112
Mailing Address - Fax:
Practice Address - Street 1:2777 ALTON PKWY APT 439
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-3158
Practice Address - Country:US
Practice Address - Phone:310-505-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer