Individual
MS. NOREEN TRESA JACK-MOONEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
80 B VETERANS BLVD, I-40, EXIT 102, ACOMA, NM 87034
(505) 552-5300
(505) 552-5828
Mailing address
2050 S BLOSSER RD, SANTA MARIA, CA 93458-7310
(805) 361-8028
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
AMD-276
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H3451
—
NM
Enumeration date
07/31/2006
Last updated
04/24/2019
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