Provider Demographics
NPI:1619686011
Name:MOREN, ROVI ANN DECIERTO SAMPAGA
Entity Type:Individual
Prefix:
First Name:ROVI ANN
Middle Name:DECIERTO SAMPAGA
Last Name:MOREN
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 1:8421 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-1917
Mailing Address - Country:US
Mailing Address - Phone:661-319-8618
Mailing Address - Fax:
Practice Address - Street 1:2737 W CECIL AVE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-1821
Practice Address - Country:US
Practice Address - Phone:661-721-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program