Healthcare Provider Details

I. General information

NPI: 1942963061
Provider Name (Legal Business Name): MIQUEL ANGEL RUANO-MORENO BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2992 NE MODA WAY APT 514
HILLSBORO OR
97124-7120
US

IV. Provider business mailing address

2992 NE MODA WAY APT 514
HILLSBORO OR
97124-7120
US

V. Phone/Fax

Practice location:
  • Phone: 925-595-6304
  • Fax:
Mailing address:
  • Phone: 925-595-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: