Healthcare Provider Details

I. General information

NPI: 1518793199
Provider Name (Legal Business Name): DAVID DWAYNE MORIN MAA, BSN, RN, CCRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7006 COMANCHE STAR
SAN ANTONIO TX
78233-3037
US

IV. Provider business mailing address

7006 COMANCHE STAR
SAN ANTONIO TX
78233-3037
US

V. Phone/Fax

Practice location:
  • Phone: 334-447-3333
  • Fax:
Mailing address:
  • Phone: 334-447-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number966727
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: