Healthcare Provider Details

I. General information

NPI: 1366338014
Provider Name (Legal Business Name): RODNEY LEE MOYER-FUENTES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9012 Q ST
OMAHA NE
68127-3549
US

IV. Provider business mailing address

9012 Q ST
OMAHA NE
68127-3549
US

V. Phone/Fax

Practice location:
  • Phone: 402-660-5657
  • Fax:
Mailing address:
  • Phone: 402-660-5657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: