Healthcare Provider Details

I. General information

NPI: 1396215943
Provider Name (Legal Business Name): PAULA MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 OYSTER POINT BLVD STE 512
SOUTH SAN FRANCISCO CA
94080-1973
US

IV. Provider business mailing address

135 3RD ST APT 4
SAN RAFAEL CA
94901-3568
US

V. Phone/Fax

Practice location:
  • Phone: 650-826-2945
  • Fax:
Mailing address:
  • Phone: 415-572-7188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010447
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number95010447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: