MEDICARE: MRS. GLORIA J. MOORE RN

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
1	3747P1801X	Personal Care Attendant	418370	TX

General Provider Information

NPI Number	:	1225304454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLORIA J. MOORE RN

Provider Business Mailing Address
First Line	:	8146 SELDON TRL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-2318
Country	:	US
Telephone Number	:	210-661-7138
Fax Number	:	210-661-7861

Provider Business Practice Location Address
First Line	:	8146 SELDON TRL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-2318
Country	:	US
Telephone Number	:	210-661-7138
Fax Number	:	210-661-7861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	04/02/2012

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