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General NPI Number Information
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NPI Number | 1124587159
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Entity Type | Individual
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Provider Name | DR. GUILLERMO MORENO JR.
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Gender | Male
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 3721 SILSBY RD
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City | UNIVERSITY HEIGHTS
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State | OH
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Zip | 44118-3647
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Country | US
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Telephone | 773-456-0028
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 METROHEALTH DR
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City | CLEVELAND
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State | OH
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Zip | 44109-1900
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Country | US
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Telephone | 773-456-0028
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 35.147718
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License Number State | OH
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