Provider Demographics
NPI:1629501150
Name:MORENO, VIRGINIA TERESA (RN)
Entity type:Individual
Prefix:MISS
First Name:VIRGINIA
Middle Name:TERESA
Last Name:MORENO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:VIRGINIA
Other - Middle Name:TERESA
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:702 WORKMAN ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-6800
Mailing Address - Country:US
Mailing Address - Phone:661-335-7140
Mailing Address - Fax:
Practice Address - Street 1:702 WORKMAN ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-6800
Practice Address - Country:US
Practice Address - Phone:661-335-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95317619163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice