Provider Demographics
NPI:1972220879
Name:MORENO, MARIA ANGELA MONIQUE S
Entity Type:Individual
Prefix:
First Name:MARIA ANGELA MONIQUE
Middle Name:S
Last Name:MORENO
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 1:2101 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6127
Mailing Address - Country:US
Mailing Address - Phone:956-687-4559
Mailing Address - Fax:
Practice Address - Street 1:630 E BRAVO BLVD STE 2
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-5721
Practice Address - Country:US
Practice Address - Phone:956-847-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1355179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist