Provider Demographics
NPI:1770081952
Name:MORENO, MARIA LUISA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LUISA
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 1:31270 SHERER RD
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-6601
Mailing Address - Country:US
Mailing Address - Phone:956-399-2300
Mailing Address - Fax:956-399-1960
Practice Address - Street 1:31270 SHERER RD
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-6601
Practice Address - Country:US
Practice Address - Phone:956-399-2300
Practice Address - Fax:956-399-1960
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant