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General NPI Number Information
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NPI Number | 1467260026
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Entity Type | Organization
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Legal Business Name | LUIS A MORENO JR MD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/27/2024
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 3810 E FLAMINGO RD
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City | LAS VEGAS
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State | NV
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Zip | 89121-6227
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Country | US
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Telephone | 818-515-7035
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Fax |
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Provider Business Mailing Address
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Address Line | 11700 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89135-1573
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Country | US
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Telephone | 818-515-7035
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Fax |
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Authorized Official
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Title or Position | DIRECT OWNER / MD
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Name | DR. LUIS A MORENO
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Credential | MD
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Telephone | 818-515-7035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State |
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