Provider Demographics
NPI:1700036589
Name:MORENO, CARMEN (MPH, RD)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 DEYERLE AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3582
Mailing Address - Country:US
Mailing Address - Phone:540-437-9575
Mailing Address - Fax:540-437-9576
Practice Address - Street 1:2040 DEYERLE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3582
Practice Address - Country:US
Practice Address - Phone:540-437-9575
Practice Address - Fax:540-437-9576
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered