MEDICARE: TRINITY MORENO BCBA

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	1-22-61562
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1578040085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRINITY MORENO BCBA

Provider Business Mailing Address
First Line	:	7065 SILVER SPUR ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-0823
Country	:	US
Telephone Number	:	575-636-7659
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 HAWKINS BLVD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1201
Country	:	US
Telephone Number	:	915-320-1625
Fax Number	:

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

Provider Enumeration Date	:	07/26/2018
Last Update Date	:	01/19/2023

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Directions to “ TRINITY MORENO BCBA” Practice Location

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