MEDICARE: MR. RICHARD ALAN MORENO CRNA

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	163W00000X	Registered Nurse	234373	TX
2	367500000X	Certified Registered Nurse Anesthetist	030543	TX

General Provider Information

NPI Number	:	1982783601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD ALAN MORENO CRNA

Provider Business Mailing Address
First Line	:	7159 CRYSTAL WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3218
Country	:	US
Telephone Number	:	713-974-3490
Fax Number	:	713-974-3483

Provider Business Practice Location Address
First Line	:	7159 CRYSTAL WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3218
Country	:	US
Telephone Number	:	713-974-3490
Fax Number	:	713-974-3483

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	09/11/2025

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