Provider Demographics
NPI:1992587877
Name:MORENO, ROSIE JARI
Entity type:Individual
Prefix:
First Name:ROSIE
Middle Name:JARI
Last Name:MORENO
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 1:1929 W FILLMORE ST BLDG C
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-3812
Mailing Address - Country:US
Mailing Address - Phone:602-258-6008
Mailing Address - Fax:
Practice Address - Street 1:1929 W FILLMORE ST BLDG C
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-3812
Practice Address - Country:US
Practice Address - Phone:602-258-6008
Practice Address - Fax:602-258-8388
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ312190363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner