MEDICARE: DR. ITTAY MORENO PEDIATRICS PLLC

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
1	208000000X	Pediatrics Physician
2	208M00000X	Hospitalist Physician

General Provider Information

NPI Number	:	1962100891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ITTAY MORENO PEDIATRICS PLLC

Provider Business Mailing Address
First Line	:	320 VIN RALIUGA CT
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-2392
Country	:	US
Telephone Number	:	915-400-5871
Fax Number	:	915-856-2458

Provider Business Practice Location Address
First Line	:	320 VIN RALIUGA CT
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-2392
Country	:	US
Telephone Number	:	915-400-5871
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ITTAY O MORENO
Credential	:	MD
Telephone Number	:	915-400-5871

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	12/11/2025

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