Healthcare Provider Details

I. General information

NPI: 1316514995
Provider Name (Legal Business Name): MARCIAL ARTURO MORENO GUTIERREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 STARR ST
MERCEDES TX
78570
US

IV. Provider business mailing address

1010 JAMES ST SUITE B
WESLACO TX
78596
US

V. Phone/Fax

Practice location:
  • Phone: 956-514-1643
  • Fax: 718-963-7957
Mailing address:
  • Phone: 718-963-7956
  • Fax: 718-963-7957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU9316
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: