Provider Demographics
NPI:1750355848
Name:MORENO, AMBER M (DO)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:M
Last Name:MORENO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:333 N SANTA ROSA ST
Mailing Address - Street 2:STE D4023
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3108
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-2609
Practice Address - Street 1:8366 N LOOP 1604 W
Practice Address - Street 2:STE 105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3533
Practice Address - Country:US
Practice Address - Phone:210-680-6000
Practice Address - Fax:210-680-9153
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM0832208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179273105Medicaid
TX8S5060OtherBCBS
TX1750355848OtherNPI
TX179273101Medicaid
TX8F2230Medicare PIN
TXI48623Medicare UPIN