Provider Demographics
NPI:1972284644
Name:MORENO, HUSAI JAVIER
Entity Type:Individual
Prefix:
First Name:HUSAI
Middle Name:JAVIER
Last Name:MORENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 W BETZ RD
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-8400
Mailing Address - Country:US
Mailing Address - Phone:509-830-1743
Mailing Address - Fax:
Practice Address - Street 1:200 PHYSICAL EDUCATION CLASSROOM
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004
Practice Address - Country:US
Practice Address - Phone:509-359-2427
Practice Address - Fax:509-359-4833
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program