Provider Demographics
NPI:1144865262
Name:MORENO, TAMMY MAE (RRT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:MAE
Last Name:MORENO
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20245 N 32ND DR APT 239
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-0310
Mailing Address - Country:US
Mailing Address - Phone:623-693-9613
Mailing Address - Fax:
Practice Address - Street 1:20245 N 32ND DR APT 239
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-0310
Practice Address - Country:US
Practice Address - Phone:623-693-9613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0051402278C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedCritical Care