Provider Demographics
NPI:1659665297
Name:MORENO-ORTA, CHRISTINE LEBLANC (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LEBLANC
Last Name:MORENO-ORTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ROSE
Other - Last Name:LEBLANC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11130 CHRISTUS HILLS
Mailing Address - Street 2:2ND FLOOR, SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251
Mailing Address - Country:US
Mailing Address - Phone:210-703-9001
Mailing Address - Fax:210-703-9155
Practice Address - Street 1:11130 CHRISTUS HILLS
Practice Address - Street 2:MEDICAL PLAZA 3, 3RD FLOOR
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3585
Practice Address - Country:US
Practice Address - Phone:210-703-9001
Practice Address - Fax:210-703-9155
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0040990390200000X
TXP6210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3262446-02Medicaid
TX314622YMJUMedicare PIN