Provider Demographics
NPI:1669130399
Name:RAMON MORENO, ISSEL (CBHCM)
Entity type:Individual
Prefix:
First Name:ISSEL
Middle Name:
Last Name:RAMON MORENO
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W 60TH ST APT F311
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6839
Mailing Address - Country:US
Mailing Address - Phone:786-247-6770
Mailing Address - Fax:
Practice Address - Street 1:1725 W 60TH ST APT F311
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6839
Practice Address - Country:US
Practice Address - Phone:786-247-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty