Healthcare Provider Details

I. General information

NPI: 1346483849
Provider Name (Legal Business Name): RACHEL ROSE MORANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 HARRISON BLVD 300
OGDEN UT
84403-2314
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-5600
  • Fax:
Mailing address:
  • Phone: 801-442-3059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0075603
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: