Organization
MMJ SURGICAL ASSISTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOSES MORENO CSFA (OWNER)
(210) 878-8357
Entity
Organization
Contact information
Practice address
2350 STATE HIGHWAY 132 N LOT 4, NATALIA, TX 78059-0522
(210) 878-8357
Mailing address
PO BOX 522, NATALIA, TX 78059-0522
(210) 878-8395
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
163769
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
163769
CSFA
TX
Enumeration date
05/26/2016
Last updated
10/10/2016
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