Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | N2673 | TX |
Y | 2084N0402X | Child Neurologist | A79062 | CA |
N | 2084N0402X | Child Neurologist | N2673 | TX |
NPI | 1164591657 |
---|---|
Provider Name | Dr. Miguel Andres Moreno |
First Address | Palo Alto, CA 94304-1510 |
Second Address | Palo Alto, CA 94304-1510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DPS 00164704 | TX MEDICAL LICENSE N2673 (01) | TX |