Individual
NEVRA LORRAINE MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4406 E SHETLAND DR, SAN TAN VALLEY, AZ 85140-3135
(602) 641-1190
Mailing address
4406 E SHETLAND DR, SAN TAN VALLEY, AZ 85140-3135
(602) 641-1190
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-25634
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT-25634
ARIZONA STATE BOARD OF MASSAGE
AZ
Enumeration date
09/21/2020
Last updated
09/21/2020
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