Provider Demographics
NPI:1033358049
Name:BRIDGET MORENO APN-BC PLLC
Entity Type:Organization
Organization Name:BRIDGET MORENO APN-BC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:V
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:210-279-3851
Mailing Address - Street 1:7603 BLUE FLAX CV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2562
Mailing Address - Country:US
Mailing Address - Phone:210-279-3851
Mailing Address - Fax:210-223-1814
Practice Address - Street 1:343 W HOUSTON ST STE 203
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2106
Practice Address - Country:US
Practice Address - Phone:210-279-3851
Practice Address - Fax:210-223-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX600172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty