Healthcare Provider Details

I. General information

NPI: 1215209481
Provider Name (Legal Business Name): CYNTHIA P MORENO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N POPE ST HIDALGO MEDICAL SERVICES
SILVER CITY NM
88061-5161
US

IV. Provider business mailing address

530 DEMOSS STREET
LORDSBURG NM
88045-2618
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1511
  • Fax: 575-542-2388
Mailing address:
  • Phone: 575-542-8384
  • Fax: 575-542-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCNP-01903
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: