Provider Demographics
NPI:1821621814
Name:MORENO-PEREZ, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MORENO-PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4748 SE 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-3433
Mailing Address - Country:US
Mailing Address - Phone:971-401-4661
Mailing Address - Fax:971-401-4661
Practice Address - Street 1:8344 SW NIMBUS AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6444
Practice Address - Country:US
Practice Address - Phone:971-202-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2022-05-12
Deactivation Date:2020-02-18
Deactivation Code:
Reactivation Date:2020-05-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No156F00000XEye and Vision Services ProvidersTechnician/Technologist