Individual
MS. LARIANN MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02721
TX
363A00000X
Physician Assistant
PA02721
TX
363AS0400X
Surgical Physician Assistant
Primary
PA02721
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88N391
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/09/2005
Last updated
09/26/2024
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