MEDICARE: NATALIA MORENO PA-C

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1679112155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIA MORENO PA-C

Provider Business Mailing Address
First Line	:	1347 LAKE FOREST DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-0619
Country	:	US
Telephone Number	:	786-486-8934
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE STE 1109
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1811
Country	:	US
Telephone Number	:	972-817-6930
Fax Number	:	972-817-6940

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

Provider Enumeration Date	:	12/31/2019
Last Update Date	:	08/08/2024

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