Provider Demographics
NPI:1407735566
Name:MORENO, RUBY LACANDAZO (CRT)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:LACANDAZO
Last Name:MORENO
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 SIPE SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-1867
Mailing Address - Country:US
Mailing Address - Phone:702-748-3155
Mailing Address - Fax:
Practice Address - Street 1:2885 SIPE SPRINGS ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-1867
Practice Address - Country:US
Practice Address - Phone:702-748-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRC4089227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified