Provider Demographics
NPI:1356056493
Name:MORENO MORALES, LOURDES
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:MORENO MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18340 MEDITERRANEAN BLVD APT 2808
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5734
Mailing Address - Country:US
Mailing Address - Phone:754-257-0204
Mailing Address - Fax:
Practice Address - Street 1:18340 MEDITERRANEAN BLVD APT 2808
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5734
Practice Address - Country:US
Practice Address - Phone:754-257-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor