MEDICARE: MISS STEPHANIE LIZETH MORENO BUENROSTRO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	207VG0400X	AZ

General Provider Information

NPI Number	:	1215882758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STEPHANIE LIZETH MORENO BUENROSTRO

Provider Business Mailing Address
First Line	:	4133 E PLEASANT LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-5148
Country	:	US
Telephone Number	:	602-339-9263
Fax Number	:

Provider Business Practice Location Address
First Line	:	4133 E PLEASANT LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-5148
Country	:	US
Telephone Number	:	602-339-9263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ MISS STEPHANIE LIZETH MORENO BUENROSTRO ” Practice Location

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