Healthcare Provider Details

I. General information

NPI: 1285439646
Provider Name (Legal Business Name): WENDY MORENO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W GRIGGS AVE
LAS CRUCES NM
88001-1234
US

IV. Provider business mailing address

1333 JOHN PHELAN DR
EL PASO TX
79936-7225
US

V. Phone/Fax

Practice location:
  • Phone: 575-277-3946
  • Fax:
Mailing address:
  • Phone: 915-256-3076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT103545
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: