Provider Demographics
NPI:1629501150
Name:MORENO, VIRGINIA TERESA (LVN II)
Entity Type:Individual
Prefix:MISS
First Name:VIRGINIA
Middle Name:TERESA
Last Name:MORENO
Suffix:
Gender:F
Credentials:LVN II
Other - Prefix:MISS
Other - First Name:VIRGINIA
Other - Middle Name:TERESA
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:1800 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-3302
Mailing Address - Country:US
Mailing Address - Phone:661-321-3000
Mailing Address - Fax:661-868-0296
Practice Address - Street 1:1800 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3302
Practice Address - Country:US
Practice Address - Phone:661-321-3000
Practice Address - Fax:661-868-0296
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289461164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse