Healthcare Provider Details

I. General information

NPI: 1881064962
Provider Name (Legal Business Name): MARIA MORENO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SKYLINE BLVD
AVENAL CA
93204-1850
US

IV. Provider business mailing address

PO BOX 700
AVENAL CA
93204-0700
US

V. Phone/Fax

Practice location:
  • Phone: 559-386-4500
  • Fax:
Mailing address:
  • Phone: 559-386-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number29294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: