MEDICARE: EMMANUEL MORENO-ORTIZ PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1710728308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL MORENO-ORTIZ PA

Provider Business Mailing Address
First Line	:	224 CANDLEWICK DR
Second Line	:
City	:	WENDELL
State	:	NC
Zip	:	27591-9474
Country	:	US
Telephone Number	:	252-327-0573
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 CURTIS ELLIS DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-2298
Country	:	US
Telephone Number	:	252-962-8000
Fax Number	:

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

Provider Enumeration Date	:	06/05/2024
Last Update Date	:	03/24/2025

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