| Graciela Moreno, M.d., P.a. | |
|
2010 Nw Military Hwy San Antonio TX 78213-2130 | |
| (210) 373-0880 | |
| (866) 232-0628 |
| Full Name | Graciela Moreno, M.d., P.a. |
|---|---|
| Speciality | General Practice |
| Location | 2010 Nw Military Hwy, San Antonio, Texas |
| Authorized Official Name and Position | Graciela Moreno (PHYSICIAN OWNER/PRESIDENT) |
| Authorized Official Contact | 2103730880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Graciela Moreno, M.d., P.a. 18702 Danforth Cv San Antonio TX 78258-4590 Ph: (210) 373-0880 | Graciela Moreno, M.d., P.a. 2010 Nw Military Hwy San Antonio TX 78213-2130 Ph: (210) 373-0880 |
| NPI Number | 1700096070 |
|---|---|
| Provider Enumeration Date | 05/23/2007 |
| Last Update Date | 12/26/2023 |
| Medicare PECOS PAC ID | 9931171311 |
|---|---|
| Medicare Enrollment ID | O20040806000701 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700096070 | NPI | - | NPPES |
| 1740253541 | Other | NPI INDIVIDUAL | |
| 8C0894 | Other | TX | MEDICARE INDIVIDUAL NUMBER |
| 1700096070 | Other | NPI GROUP | |
| 168973901 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | L4580 (Texas) | Primary |
| Provider Name | Graciela Moreno |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740253541 PECOS PAC ID: 0345212734 Enrollment ID: I20040809000378 |
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