Provider Demographics
NPI:1669921862
Name:MORENO, DEVIN
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:MORENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 ANGELINA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2558
Mailing Address - Country:US
Mailing Address - Phone:361-249-3274
Mailing Address - Fax:361-266-3195
Practice Address - Street 1:5337 YORKTOWN BLVD STE 4A1
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5361
Practice Address - Country:US
Practice Address - Phone:361-249-3274
Practice Address - Fax:361-266-3195
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01724171100000X
TX171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist