Healthcare Provider Details

I. General information

NPI: 1376342287
Provider Name (Legal Business Name): ILIANA MOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 367 821 J ST
COZAD NE
69130-0367
US

IV. Provider business mailing address

PO BOX 367 821 J ST
COZAD NE
69130-0367
US

V. Phone/Fax

Practice location:
  • Phone: 308-784-4222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: