Provider Demographics
NPI:1750527966
Name:ALEJANDRA MORENO MD PA
Entity type:Organization
Organization Name:ALEJANDRA MORENO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ALEJANDRA
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-769-1045
Mailing Address - Street 1:1901 HIGHWAY 97 E
Mailing Address - Street 2:SUITE 120
Mailing Address - City:JOURDANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78026-1517
Mailing Address - Country:US
Mailing Address - Phone:830-769-1045
Mailing Address - Fax:830-769-1105
Practice Address - Street 1:1901 HIGHWAY 97 E
Practice Address - Street 2:SUITE 120
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-1517
Practice Address - Country:US
Practice Address - Phone:830-769-1045
Practice Address - Fax:830-769-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXY0160463OtherDPS
TX200692601Medicaid
TXN0999OtherMEDICAL LICENSE
TXN0999OtherMEDICAL LICENSE