Healthcare Provider Details

I. General information

NPI: 1316730203
Provider Name (Legal Business Name): JAYSEN EDUARDO MORENO AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 N 3RD AVE # 330
PHOENIX AZ
85013-4434
US

IV. Provider business mailing address

240 W THOMAS RD # 301
PHOENIX AZ
85013-4407
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-8811
  • Fax: 602-406-8810
Mailing address:
  • Phone: 602-406-7765
  • Fax: 602-294-5519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA16225
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: