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General NPI Number Information
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NPI Number | 1033358049
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Entity Type | Organization
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Legal Business Name | BRIDGET MORENO APN-BC PLLC
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Dates
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Enumeration Date | 02/13/2009
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Last Update Date | 02/13/2009
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Provider Practice Location Address
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Address Line | 343 W HOUSTON ST STE 203
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2106
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Country | US
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Telephone | 210-279-3851
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Fax | 210-223-1814
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Provider Business Mailing Address
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Address Line | 7603 BLUE FLAX CV
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2562
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Country | US
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Telephone | 210-279-3851
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Fax | 210-223-1814
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIDGET V MORENO
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Credential | NP
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Telephone | 210-279-3851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 600172
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License Number State | TX
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