Healthcare Provider Details

I. General information

NPI: 1861721037
Provider Name (Legal Business Name): SOFIA TERESA MORENO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 LAWRENCE EXPY
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

231 EASY ST UNIT 9
MOUNTAIN VIEW CA
94043-3760
US

V. Phone/Fax

Practice location:
  • Phone: 951-353-2141
  • Fax:
Mailing address:
  • Phone: 951-204-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA104491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: