Provider Demographics
NPI:1619584703
Name:MORENO, MARIA E
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
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 1:10761 E AVENIDA DEL CAMPO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-7042
Mailing Address - Country:US
Mailing Address - Phone:520-207-9237
Mailing Address - Fax:
Practice Address - Street 1:10761 E AVENIDA DEL CAMPO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-7042
Practice Address - Country:US
Practice Address - Phone:520-207-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10160H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility