Provider Demographics
NPI:1457658056
Name:LUPITA MORENO
Entity Type:Organization
Organization Name:LUPITA MORENO
Other - Org Name:RIO GRANDE AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUPITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-776-5202
Mailing Address - Street 1:2320 DEL RIO BLVD SUITE D
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852
Mailing Address - Country:US
Mailing Address - Phone:830-776-5202
Mailing Address - Fax:830-776-5329
Practice Address - Street 1:2320 DEL RIO BLVD STE D
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-3980
Practice Address - Country:US
Practice Address - Phone:830-776-5202
Practice Address - Fax:830-776-5329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000556341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance