Basic Information
| Provider Information | |||||||||
| NPI: | 1265743397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORENO | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34876 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256565412 | ||||||||
| FaxNumber: | 4256564096 | ||||||||
| Practice Location | |||||||||
| Address1: | 3915 TALBOT RD S | ||||||||
| Address2: | STE 401 | ||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980555738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256564224 | ||||||||
| FaxNumber: | 4256565099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2010 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 125057636 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 208M00000X | 1362895-1205 | UT | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | MD60382871 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.