Provider Demographics
NPI:1770252819
Name:MORENO, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15320 JOE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78725-2960
Mailing Address - Country:US
Mailing Address - Phone:512-221-4584
Mailing Address - Fax:
Practice Address - Street 1:7112 ED BLUESTEIN BLVD STE 125
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2924
Practice Address - Country:US
Practice Address - Phone:512-926-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician