Provider Demographics
NPI:1891764353
Name:DE LA MORENA, MARIA TERESA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:
Last Name:DE LA MORENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:M/S: HB.B.501
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-987-7450
Mailing Address - Fax:206-985-3119
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:M/S: HB.B.501
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-987-7450
Practice Address - Fax:206-985-3119
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM25982080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060847302Medicaid
H01288Medicare UPIN
TX060847302Medicaid