Provider Demographics
NPI:1891344776
Name:MORENO, MAGDALENO II
Entity type:Individual
Prefix:
First Name:MAGDALENO
Middle Name:
Last Name:MORENO
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9565 LOS OLMOS
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-4589
Mailing Address - Country:US
Mailing Address - Phone:956-742-9670
Mailing Address - Fax:956-545-0009
Practice Address - Street 1:1393 E ALTON GLOOR BLVD STE 8
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3401
Practice Address - Country:US
Practice Address - Phone:956-545-0009
Practice Address - Fax:956-545-0009
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician