| NPI | 1811101603 |
|---|---|
| Former Name | MONSERATE MORENO ANDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA VN207724) |
| Additional Taxonomies | 261QM2800X Clinic/Center Methadone (Licence: CA 37-07) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2007-07-08 |