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NPI Code Detail

MEDICARE: THEDA JUANA MORENO

MEDICARE: THEDA JUANA MORENO
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
1175T00000XPeer SpecialistOK

General Provider Information

NPI Number : 1568261360
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEDA JUANA MORENO
Provider Business Mailing Address
First Line : 4037 RANCHO DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73119-4048
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1950 S SHEPARD AVE
Second Line :
City : EL RENO
State : OK
Zip : 73036-6357
Country : US
Telephone Number : 405-549-3519
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2025
Last Update Date : 03/12/2025

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Directions to “ THEDA JUANA MORENO ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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