Provider Demographics
NPI:1467088641
Name:MOUMOUNI, RACHEL LONGORIA
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LONGORIA
Last Name:MOUMOUNI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6807 HEATHERBROOK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3017
Mailing Address - Country:US
Mailing Address - Phone:830-275-9361
Mailing Address - Fax:
Practice Address - Street 1:6807 HEATHERBROOK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3017
Practice Address - Country:US
Practice Address - Phone:830-275-9361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176574164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse