Provider Demographics
NPI:1457985954
Name:MOREIRA, CAROLINA (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:MOREIRA
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18711 SHERMAN WAY UNIT 105A
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4086
Mailing Address - Country:US
Mailing Address - Phone:818-578-3735
Mailing Address - Fax:
Practice Address - Street 1:18711 SHERMAN WAY UNIT 105A
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4086
Practice Address - Country:US
Practice Address - Phone:818-578-3735
Practice Address - Fax:818-975-5316
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based