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NPI Code Detail

MEDICARE: PABLO EDMUNDO MORENO

MEDICARE: PABLO EDMUNDO MORENO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-25-476117NM

General Provider Information

NPI Number : 1194618389
Entity Type Code : Individual
Provider Name (Legal Business Name) : PABLO EDMUNDO MORENO
Provider Business Mailing Address
First Line : 301 PERKINS DR STE B
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-3248
Country : US
Telephone Number : 575-652-3155
Fax Number : 575-652-0164
Provider Business Practice Location Address
First Line : 1675 HICKORY LOOP
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-6587
Country : US
Telephone Number : 575-652-3155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2025
Last Update Date : 03/09/2026

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Directions to “ PABLO EDMUNDO MORENO ” Practice Location

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