Provider Demographics
NPI:1144883760
Name:MORENO, SONIA R (DIPLOMA HS)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:R
Last Name:MORENO
Suffix:
Gender:F
Credentials:DIPLOMA HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 BLANCO CIR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4401
Mailing Address - Country:US
Mailing Address - Phone:831-424-6655
Mailing Address - Fax:
Practice Address - Street 1:913 BLANCO CIR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4401
Practice Address - Country:US
Practice Address - Phone:831-424-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATBAOtherADMINISTRATIVE SERVICES