Healthcare Provider Details

I. General information

NPI: 1629501150
Provider Name (Legal Business Name): VIRGINIA TERESA MORENO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA TERESA MORENO RN

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 WORKMAN ST
BAKERSFIELD CA
93307-6800
US

IV. Provider business mailing address

702 WORKMAN ST
BAKERSFIELD CA
93307-6800
US

V. Phone/Fax

Practice location:
  • Phone: 661-335-7140
  • Fax:
Mailing address:
  • Phone: 661-335-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95317619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: