Healthcare Provider Details

I. General information

NPI: 1376732099
Provider Name (Legal Business Name): EDUARDO MORENO, M.D., RURAL HEALTH CLINIC, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S AVENUE C
CRYSTAL CITY TX
78839-3834
US

IV. Provider business mailing address

210 S AVENUE C P.O. BOX 725
CRYSTAL CITY TX
78839-3834
US

V. Phone/Fax

Practice location:
  • Phone: 830-374-2952
  • Fax: 830-374-3784
Mailing address:
  • Phone: 830-374-2952
  • Fax: 830-374-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE3738
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. HELEN E MORENO
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 210-497-4272