| Organization Name: | GRACIELA MORENO, M.D., P.A. |
| NPI Number: | 1700096070 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GRACIELA MORENO (PRESIDENT) |
| Mailing Address: | 10003 Nw Military Hwy Suite 2217 San Antonio |
| State: | TX US |
| Postal Code: | 782311885 |
| Phone Number: | 2104032998 |
| Fax Number: | 2104020418 |
| NPI Enumeration Date: | 05/23/2007 |
| NPI Last Update Date: | 09/30/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | L4580 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |