Provider Demographics
NPI:1013885011
Name:SAN, MOO MOO
Entity type:Individual
Prefix:
First Name:MOO
Middle Name:MOO
Last Name:SAN
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 1:10525 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1085
Mailing Address - Country:US
Mailing Address - Phone:402-507-6942
Mailing Address - Fax:
Practice Address - Street 1:10525 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1085
Practice Address - Country:US
Practice Address - Phone:402-507-6942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-29
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant