Healthcare Provider Details

I. General information

NPI: 1811643851
Provider Name (Legal Business Name): CONSUELO MORENO BOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 N LOOP 1604 E
SAN ANTONIO TX
78247-3801
US

IV. Provider business mailing address

6007 KENILWORTH BLVD
SPRING BRANCH TX
78070-7242
US

V. Phone/Fax

Practice location:
  • Phone: 210-651-0279
  • Fax:
Mailing address:
  • Phone: 210-269-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number32385
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: