Provider Demographics
NPI:1184125510
Name:MORENO, CELAINE EVETTE (ND)
Entity type:Individual
Prefix:
First Name:CELAINE
Middle Name:EVETTE
Last Name:MORENO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7812 S 48TH DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7301
Mailing Address - Country:US
Mailing Address - Phone:602-733-4001
Mailing Address - Fax:
Practice Address - Street 1:6730 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3141
Practice Address - Country:US
Practice Address - Phone:480-420-4756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18-1694175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath