Provider Demographics
NPI:1811559453
Name:MORENO, FERNANDO (CRM)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:MORENO
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 NE FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3160
Mailing Address - Country:US
Mailing Address - Phone:503-891-8343
Mailing Address - Fax:503-238-5202
Practice Address - Street 1:2720 NE FLANDERS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3160
Practice Address - Country:US
Practice Address - Phone:503-891-8343
Practice Address - Fax:503-238-5202
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist