Individual
MR. JEREMIAH MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1104-1 MEDICAL ARTS NE, BUILDING 4, SUITE B, ALBUQUERQUE, NM 87102
(227) 227-2505
Mailing address
1259 MIRADOR LOOP NE, RIO RANCHO, NM 87144-5327
(505) 514-8482
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2020-0108
NM
Other
Enumeration date
12/09/2020
Last updated
06/08/2023
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