Healthcare Provider Details

I. General information

NPI: 1356943252
Provider Name (Legal Business Name): SIERRA MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 OLD MAIN HL
LOGAN UT
84322-7425
US

IV. Provider business mailing address

925 W 2075 S
LOGAN UT
84321-7289
US

V. Phone/Fax

Practice location:
  • Phone: 435-797-1850
  • Fax:
Mailing address:
  • Phone: 562-505-4230
  • 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: