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General NPI Number Information
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NPI Number | 1124144746
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Entity Type | Individual
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Provider Name | KIM MOCTEZUMA
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2345 BENT WAY
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City | LONGMONT
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State | CO
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Zip | 80503-7614
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Country | US
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Telephone | 303-678-3316
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Fax |
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Provider Business Mailing Address
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Address Line | 1729 DUCHESS DR
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City | LONGMONT
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State | CO
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Zip | 80501-2031
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Country | US
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Telephone | 720-280-1260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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