Mario Moreno, ANP
Family Medicine in Douglas, AZ. Individual provider (NPI-1).
NPI number1720042385
StatusActive
Last updated in NPPESJun 12, 2013
Details
- NPI
- 1720042385
- Entity type
- Individual (NPI-1)
- Name
- Mario Moreno
- Credential
- ANP
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 12, 2006
- Last updated
- Jun 12, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 0505526 | AZ | Yes |
Practice location
1100 F AveDouglas, AZ 85607-1919
Phone 520-364-1429 · Fax 520-364-4261
Mailing address
1205 F. AvenueDouglas, AZ 85607
Phone 520-364-1429 · Fax 520-364-4261
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