MEDICARE: LUIS A MORENO JR MD PROFESSIONAL CORPORATION

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician

General Provider Information

NPI Number	:	1467260026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUIS A MORENO JR MD PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	11700 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1573
Country	:	US
Telephone Number	:	818-515-7035
Fax Number	:

Provider Business Practice Location Address
First Line	:	3810 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6227
Country	:	US
Telephone Number	:	818-515-7035
Fax Number	:

Authorized Official
Title or Position	:	DIRECT OWNER / MD
Name	:	DR. LUIS A MORENO
Credential	:	MD
Telephone Number	:	818-515-7035

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	12/27/2024

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