Healthcare Provider Details

I. General information

NPI: 1083370688
Provider Name (Legal Business Name): MARTHA MORENO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 W PUTNAM AVE STE 9
PORTERVILLE CA
93257-3257
US

IV. Provider business mailing address

590 W PUTNAM AVE STE 9
PORTERVILLE CA
93257-3257
US

V. Phone/Fax

Practice location:
  • Phone: 559-781-4100
  • Fax: 559-781-1230
Mailing address:
  • Phone: 559-781-4100
  • Fax: 559-781-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95018393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: