Provider Demographics
NPI:1225304454
Name:MOORE, GLORIA J (RN)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:J
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8146 SELDON TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-2318
Mailing Address - Country:US
Mailing Address - Phone:210-661-7138
Mailing Address - Fax:210-661-7861
Practice Address - Street 1:8146 SELDON TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-2318
Practice Address - Country:US
Practice Address - Phone:210-661-7138
Practice Address - Fax:210-661-7861
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4183703747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant