Provider Demographics
NPI:1114030681
Name:MORENO, MELISSA L (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:MORENO
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8426 SPRINGFIELD GORGE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8426 SPRINGFIELD GORGE DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3543
Practice Address - Country:US
Practice Address - Phone:254-258-4649
Practice Address - Fax:315-772-9498
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-08-03
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN