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NPI Code Detail

MEDICARE: JUAN G MORONES

MEDICARE: JUAN G MORONES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164X00000XLicensed Vocational Nurse320225TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1320225OTHERTXLVN

General Provider Information

NPI Number : 1205315603
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN G MORONES
Provider Business Mailing Address
First Line : 5954 E MAIN ST
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75961-1730
Country : US
Telephone Number : 903-780-0420
Fax Number :
Provider Business Practice Location Address
First Line : 1255 W 15TH ST
Second Line :
City : PLANO
State : TX
Zip : 75075-7299
Country : US
Telephone Number : 972-673-0404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2018
Last Update Date : 08/07/2018

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Directions to “ JUAN G MORONES ” Practice Location

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