Provider Demographics
NPI:1063805190
Name:MORENO, RODRIGO (FNP-BC)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:MORENO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 NE LOOP 410
Mailing Address - Street 2:JOHNS HOPKINS WELLNESS CLINIC
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-5409
Mailing Address - Country:US
Mailing Address - Phone:210-662-3565
Mailing Address - Fax:
Practice Address - Street 1:6100 NE LOOP 410
Practice Address - Street 2:JOHNS HOPKINS WELLNESS CLINIC
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-5409
Practice Address - Country:US
Practice Address - Phone:210-662-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127108363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily