Provider Demographics
NPI:1639346927
Name:NASCIMENTO, MOIRA CRISTINA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MOIRA
Middle Name:CRISTINA
Last Name:NASCIMENTO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MC WHORTER ST.
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105
Mailing Address - Country:US
Mailing Address - Phone:973-494-0858
Mailing Address - Fax:844-857-2827
Practice Address - Street 1:225 MC WHORTER ST.
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105
Practice Address - Country:US
Practice Address - Phone:973-494-0858
Practice Address - Fax:844-857-2827
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00072600171100000X
NY001744171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist