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General NPI Number Information
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NPI Number | 1699656751
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Entity Type | Individual
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Provider Name | MARK MORENO
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Gender | Male
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 13800 N FM 620 RD
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City | AUSTIN
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State | TX
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Zip | 78717-1126
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Country | US
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Telephone | 520-612-0466
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Fax | 520-372-0987
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Provider Business Mailing Address
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Address Line | PO BOX 65985
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City | TUCSON
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State | AZ
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Zip | 85728-5985
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1166223
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License Number State | TX
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