Organization
GRACIELA MORENO, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRACIELA MORENO MD (PHYSICIAN OWNER/PRESIDENT)
(210) 373-0880
Entity
Organization
Contact information
Practice address
2010 NW MILITARY HWY, SAN ANTONIO, TX 78213-2130
(210) 373-0880
(866) 232-0628
Mailing address
18702 DANFORTH CV, SAN ANTONIO, TX 78258-4590
(210) 373-0880
(866) 232-0628
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
L4580
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168973901
—
TX
01
—
1700096070
NPI GROUP
—
01
—
1740253541
NPI INDIVIDUAL
—
01
—
8C0894
MEDICARE INDIVIDUAL NUMBER
TX
Enumeration date
05/23/2007
Last updated
12/26/2023
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