Provider Demographics
NPI:1942061502
Name:MORENO, GIRANDY PATRICIA
Entity Type:Individual
Prefix:
First Name:GIRANDY
Middle Name:PATRICIA
Last Name:MORENO
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 1:45 STUART ST APT 2311
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-4772
Mailing Address - Country:US
Mailing Address - Phone:407-222-6657
Mailing Address - Fax:
Practice Address - Street 1:17 LOWES DR # 633-3597
Practice Address - Street 2:
Practice Address - City:TILTON
Practice Address - State:NH
Practice Address - Zip Code:03276-5165
Practice Address - Country:US
Practice Address - Phone:603-633-3597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program