MEDICARE: LUIS ADALBERTO MORENO JR. MD

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	A72309	CA
2	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	24727	NV
3	207P00000X	Emergency Medicine Physician	24727	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477519163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS ADALBERTO MORENO JR. MD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2006
Last Update Date	:	03/10/2025

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