Provider Demographics
NPI:1548934599
Name:MORENO, KARLA SUSANA
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:SUSANA
Last Name:MORENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:SUSANA
Other - Last Name:GUTIERREZ MENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:909 VIA NORTE LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6641
Mailing Address - Country:US
Mailing Address - Phone:915-525-6057
Mailing Address - Fax:
Practice Address - Street 1:1485 GEORGE DIETER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7650
Practice Address - Country:US
Practice Address - Phone:915-790-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily