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General NPI Number Information
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NPI Number | 1306269949
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Entity Type | Organization
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Legal Business Name | BRIDGET MORENOAPN-BC PLLC
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 6756 STONYKIRK RD
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City | SAN ANTONIO
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State | TX
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Zip | 78240-2483
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Country | US
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Telephone | 210-279-3851
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Fax |
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Provider Business Mailing Address
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Address Line | 6756 STONYKIRK RD
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City | SAN ANTONIO
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State | TX
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Zip | 78240-2483
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Country | US
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Telephone | 210-279-3851
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. 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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 600172
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License Number State | TX
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