Provider Demographics
NPI:1801372040
Name:HERNANDEZ MORENO, MIGUEL A (RESIDENT IN TRAINING)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:HERNANDEZ MORENO
Suffix:
Gender:M
Credentials:RESIDENT IN TRAINING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 S 5TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-2927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 S 5TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2927
Practice Address - Country:US
Practice Address - Phone:956-632-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10087756390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program