Healthcare Provider Details

I. General information

NPI: 1508377961
Provider Name (Legal Business Name): PRYSILLA MORENO ND, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S 320TH ST STE E
FEDERAL WAY WA
98003-5254
US

IV. Provider business mailing address

1911 SW CAMPUS DR # 623
FEDERAL WAY WA
98023-6473
US

V. Phone/Fax

Practice location:
  • Phone: 253-237-4704
  • Fax: 833-471-4454
Mailing address:
  • Phone: 253-431-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60791810
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: