Healthcare Provider Details

I. General information

NPI: 1609860865
Provider Name (Legal Business Name): ESNEDA MARIA MORENO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 AVENUE D
KATY TX
77493-1652
US

IV. Provider business mailing address

1812 AVENUE D
KATY TX
77493-1653
US

V. Phone/Fax

Practice location:
  • Phone: 281-391-4466
  • Fax: 281-391-4494
Mailing address:
  • Phone: 281-391-4466
  • Fax: 281-391-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateTX

VIII. Authorized Official

Name: MRS. ESNEDA MARIA MORENO
Title or Position: OWNER
Credential:
Phone: 281-391-4466