Healthcare Provider Details

I. General information

NPI: 1891525614
Provider Name (Legal Business Name): MARIA G MORENO M.S., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 JAIME ZAPATA MEMORIAL HWY
LAREDO TX
78043-4769
US

IV. Provider business mailing address

3507 JAIME ZAPATA MEMORIAL HWY
LAREDO TX
78043-4769
US

V. Phone/Fax

Practice location:
  • Phone: 956-753-6355
  • Fax:
Mailing address:
  • Phone: 956-701-9578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number125011
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: