Individual
MIRA LUNA FUENTES MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1874 4TH ST, WYANDOTTE, MI 48192-3905
(734) 828-9599
Mailing address
PO BOX 265, WYANDOTTE, MI 48192-0265
(734) 828-9599
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
Primary
—
—
Other
Enumeration date
01/12/2022
Last updated
01/12/2022
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