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General NPI Number Information
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NPI Number | 1295149128
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Entity Type | Individual
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Provider Name | INGRID MORENO DUARTE MD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2014
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 5323 HARRY HINES BLVD # CS2.606
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City | DALLAS
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State | TX
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Zip | 75390-7208
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Country | US
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Telephone | 617-304-8044
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Fax |
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Provider Business Mailing Address
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Address Line | 5323 HARRY HINES BLVD # CS2.606
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City | DALLAS
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State | TX
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Zip | 75390-7208
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Country | US
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Telephone | 617-304-8044
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 259913
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | S7100
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License Number State | TX
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