Organization
IN-SPEC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JESUS MORENO CONTRACTOR (OWNER)
(210) 699-0458
Entity
Organization
Contact information
Practice address
6865 STONYKIRK ST, SAN ANTONIO, TX 78240-2744
(210) 699-0458
(210) 699-8914
Mailing address
6865 STONYKIRK ST, SAN ANTONIO, TX 78240-2744
(210) 699-0458
(210) 699-8914
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
ICI433
TX
Other
Enumeration date
11/01/2007
Last updated
06/16/2008
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