Provider Demographics
NPI:1144117987
Name:MORENO, ALYSSA RENEE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RENEE
Last Name:MORENO
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:RENEE
Other - Last Name:MUNIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1125 MARATHON PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5875
Mailing Address - Country:US
Mailing Address - Phone:915-329-4167
Mailing Address - Fax:
Practice Address - Street 1:1541 N ZARAGOZA RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7906
Practice Address - Country:US
Practice Address - Phone:915-219-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1175941208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics