Provider Demographics
NPI:1821444266
Name:MORENO, MOSES (CSFA)
Entity Type:Individual
Prefix:
First Name:MOSES
Middle Name:
Last Name:MORENO
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 522
Mailing Address - Street 2:
Mailing Address - City:NATALIA
Mailing Address - State:TX
Mailing Address - Zip Code:78059-0522
Mailing Address - Country:US
Mailing Address - Phone:210-878-8357
Mailing Address - Fax:
Practice Address - Street 1:2350 STATE HIGHWAY 132 N LOT 4 UNIT 522
Practice Address - Street 2:
Practice Address - City:NATALIA
Practice Address - State:TX
Practice Address - Zip Code:78059-0522
Practice Address - Country:US
Practice Address - Phone:210-878-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163769246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant