Provider Demographics
NPI:1598952673
Name:MORENO, ILIANA IRENE
Entity Type:Individual
Prefix:
First Name:ILIANA
Middle Name:IRENE
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 1:3415 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-3648
Mailing Address - Country:US
Mailing Address - Phone:916-875-2995
Mailing Address - Fax:916-875-2921
Practice Address - Street 1:3415 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-3648
Practice Address - Country:US
Practice Address - Phone:916-875-2995
Practice Address - Fax:916-875-2921
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide