Healthcare Provider Details

I. General information

NPI: 1326981010
Provider Name (Legal Business Name): UPSTREAM ROOT CAUSE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8031 W CENTER RD STE 221
OMAHA NE
68124-3134
US

IV. Provider business mailing address

8031 W CENTER RD STE 221
OMAHA NE
68124-3134
US

V. Phone/Fax

Practice location:
  • Phone: 402-343-7963
  • Fax: 866-305-8318
Mailing address:
  • Phone: 402-343-7963
  • Fax: 866-305-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JORGE LUIS MORENO
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 402-343-7963