Individual
MARK MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13800 N FM 620 RD, AUSTIN, TX 78717-1126
(520) 612-0466
(520) 372-0987
Mailing address
PO BOX 65985, TUCSON, AZ 85728-5985
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1166223
TX
Other
Enumeration date
09/08/2025
Last updated
09/11/2025
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