# GRACIELA MORENO, M.D., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700096070
- **Authorized official:** DR. GRACIELA MORENO MD (PHYSICIAN OWNER/PRESIDENT)
- **Authorized official phone:** (210) 373-0880

## Contact information

- **Practice address:** 2010 NW MILITARY HWY, SAN ANTONIO, TX 78213-2130
- **Practice address phone:** (210) 373-0880
- **Practice address fax:** (866) 232-0628
- **Mailing address:** 18702 DANFORTH CV, SAN ANTONIO, TX 78258-4590
- **Mailing address phone:** (210) 373-0880
- **Mailing address fax:** (866) 232-0628

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | L4580 | TX | Yes |

## Other

- **Enumeration date:** 05/23/2007
- **Last updated:** 12/26/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 168973901 | — | TX |
| 01 | — | 1700096070 | NPI GROUP | — |
| 01 | — | 1740253541 | NPI INDIVIDUAL | — |
| 01 | — | 8C0894 | MEDICARE INDIVIDUAL NUMBER | TX |