Provider Demographics
NPI:1336770387
Name:MORONES HERNANDEZ, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MORONES HERNANDEZ
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 1:502 E RAMSEY RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4639
Mailing Address - Country:US
Mailing Address - Phone:210-490-3900
Mailing Address - Fax:210-419-0391
Practice Address - Street 1:502 E RAMSEY RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4639
Practice Address - Country:US
Practice Address - Phone:210-490-3900
Practice Address - Fax:210-419-0391
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20017219479103K00000X
TX4905103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1114164431OtherTLC KIDS THERAPY NPI