Individual
ROBERTO ANTONIO MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2462 WHITE OAK AVE, WHITING, IN 46394-2157
(219) 999-5869
Mailing address
PO BOX 752, WHITING, IN 46394-0752
(219) 999-5869
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
21-015157
IN
Other
Enumeration date
10/13/2021
Last updated
12/12/2024
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