Provider Demographics
NPI:1740401397
Name:MOMEN, DOREEN
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:
Last Name:MOMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DOREEN
Other - Middle Name:JUANITA
Other - Last Name:BRITTAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1221 FULTON MALL
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1915
Mailing Address - Country:US
Mailing Address - Phone:559-445-3449
Mailing Address - Fax:559-445-3370
Practice Address - Street 1:1221 FULTON MALL
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1915
Practice Address - Country:US
Practice Address - Phone:559-445-3449
Practice Address - Fax:559-445-3370
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259197163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse