Provider Demographics
NPI:1063603256
Name:MORENO, ALVARO II (MD)
Entity type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:
Last Name:MORENO
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 BUSINESS CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5359
Mailing Address - Country:US
Mailing Address - Phone:800-762-9244
Mailing Address - Fax:786-672-6006
Practice Address - Street 1:1768 BUSINESS CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5359
Practice Address - Country:US
Practice Address - Phone:800-762-9244
Practice Address - Fax:786-672-6006
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1478982084P0800X
TXP75172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
4666397245OtherMYUTMB 4666397245