Provider Demographics
NPI:1023791829
Name:MORENO, JAZMINE ALEXIS (DPT)
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:ALEXIS
Last Name:MORENO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JAZZ
Other - Middle Name:
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:28 MANO DR
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:335 HOOHANA ST STE F
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3527
Practice Address - Country:US
Practice Address - Phone:808-446-2032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist