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General NPI Number Information
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NPI Number | 1396098562
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Entity Type | Individual
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Provider Name | EMILY RENEE MORENO FNP
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Gender | Female
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 1552 NIGHTFALL LN
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City | CHULA VISTA
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State | CA
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Zip | 91915-1950
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Country | US
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Telephone | 619-518-2438
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Fax | 619-428-7952
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Provider Business Mailing Address
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Address Line | 4004 BEYER BLVD
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City | SAN YSIDRO
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State | CA
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Zip | 92173-2007
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Country | US
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Telephone | 619-662-4100
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Fax | 619-428-7952
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1678229
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 599565
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0997112-NP
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 0997112-NP
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 22468
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License Number State | CA
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