Healthcare Provider Details

I. General information

NPI: 1184535312
Provider Name (Legal Business Name): NORMA RODARTE MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 CAPE HORN DR
SAN JOSE CA
95133-1509
US

IV. Provider business mailing address

37720 FREMONT BLVD
FREMONT CA
94536-5025
US

V. Phone/Fax

Practice location:
  • Phone: 510-797-0861
  • Fax:
Mailing address:
  • Phone: 510-797-0861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240106312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: