Provider Demographics
NPI:1598409146
Name:MORENO SERRANO, ROMULO ALBERTS
Entity Type:Individual
Prefix:
First Name:ROMULO
Middle Name:ALBERTS
Last Name:MORENO SERRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 NEWSOM CIR APT C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5857
Mailing Address - Country:US
Mailing Address - Phone:407-724-1629
Mailing Address - Fax:
Practice Address - Street 1:4425 NEWSOM CIR APT C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5857
Practice Address - Country:US
Practice Address - Phone:407-724-1629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician