Provider Demographics
NPI:1548982903
Name:MORENO PEREZ, RENATA
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:MORENO PEREZ
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 1:151 W 7TH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2676
Mailing Address - Country:US
Mailing Address - Phone:541-682-4041
Mailing Address - Fax:541-682-2455
Practice Address - Street 1:151 W 7TH AVE STE 310
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2676
Practice Address - Country:US
Practice Address - Phone:541-682-4041
Practice Address - Fax:541-682-2455
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000106734172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker