Healthcare Provider Details

I. General information

NPI: 1245640481
Provider Name (Legal Business Name): WALTER F MOREANO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 EAST FWY STE 510
HOUSTON TX
77015-5623
US

IV. Provider business mailing address

12605 EAST FWY STE 510
HOUSTON TX
77015-5623
US

V. Phone/Fax

Practice location:
  • Phone: 713-453-3323
  • Fax:
Mailing address:
  • Phone: 713-453-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. YANNE SABA
Title or Position: OFFICE MANAGER
Credential:
Phone: 713-453-3323