Provider Demographics
NPI:1801247473
Name:MORENO GARCIA, LAURA ALEJANDRA (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ALEJANDRA
Last Name:MORENO GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 S NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7300
Mailing Address - Country:US
Mailing Address - Phone:417-269-2000
Mailing Address - Fax:561-360-2650
Practice Address - Street 1:3443 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7308
Practice Address - Country:US
Practice Address - Phone:417-269-2000
Practice Address - Fax:417-269-2038
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME146863208000000X, 208000000X
MO2024036671208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics