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General NPI Number Information
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NPI Number | 1932885126
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Entity Type | Organization
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Legal Business Name | LEROY MORENO PA-C PLLC
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Dates
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Enumeration Date | 06/23/2023
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 1506 S LONE STAR WAY STE 7
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City | EDINBURG
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State | TX
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Zip | 78539-4977
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Country | US
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Telephone | 956-348-2918
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Fax | 956-348-2927
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Provider Business Mailing Address
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Address Line | 1506 LONESTAR PLAZA WAY STE 7
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City | EDINBURG
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State | TX
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Zip | 78539
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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 | OWNER
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Name | LEROY MORENO
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Credential | PA
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Telephone | 956-648-5011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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