Provider Demographics
NPI:1821742396
Name:MORENO, MYRNA CATALINA
Entity Type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:CATALINA
Last Name:MORENO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MYRNA
Other - Middle Name:CATALINA
Other - Last Name:RODRIGUEZ GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3902 NE 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-6454
Mailing Address - Country:US
Mailing Address - Phone:360-607-9616
Mailing Address - Fax:
Practice Address - Street 1:3902 NE 123RD AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-6454
Practice Address - Country:US
Practice Address - Phone:360-607-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter