MEDICARE: MONICA MORONES HERNANDEZ

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	103K00000X	Behavior Analyst	20017219479	TX
2	103K00000X	Behavior Analyst	4905	TX

General Provider Information

NPI Number	:	1336770387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA MORONES HERNANDEZ

Provider Business Mailing Address
First Line	:	502 E RAMSEY RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4639
Country	:	US
Telephone Number	:	210-490-3900
Fax Number	:	210-419-0391

Provider Business Practice Location Address
First Line	:	8200 PERRIN BEITEL RD STE 112
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-1547
Country	:	US
Telephone Number	:	726-208-7474
Fax Number	:

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

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	05/21/2024

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