Provider Demographics
NPI:1922843283
Name:MORENO URIAS, RITA ELENA
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:ELENA
Last Name:MORENO URIAS
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 1:1711 N 159TH AVE UNIT 2004
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7187
Mailing Address - Country:US
Mailing Address - Phone:480-742-9857
Mailing Address - Fax:
Practice Address - Street 1:3104 E CAMELBACK RD STE 2969
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4502
Practice Address - Country:US
Practice Address - Phone:844-362-7943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician