| Organization Name: | JOHNNY C. MORENO, MD PA |
| NPI Number: | 1861421059 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHNNY C. MORENO (PRESIDENT) |
| Mailing Address: | 606 N 13th St Artesia |
| State: | NM US |
| Postal Code: | 882101165 |
| Phone Number: | 5757481266 |
| Fax Number: | 5757488822 |
| NPI Enumeration Date: | 07/01/2006 |
| NPI Last Update Date: | 10/01/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 80-218 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |