| Doctor Name: | DR. JOHNNY C. MORENO |
| NPI Number: | 1871591701 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 80-218 |
| Business Practice Address: | 606 N 13th St Artesia, NM - 882101165 |
| Business Phone Number: | 5757481266 |
| Business Fax Number: | 5757488822 |
| Mailing Address: | 606 N 13th St, ARTESIA |
| State: | NM |
| Postal Code: | 882101165 |
| Phone Number: | 5757481266 |
| Fax Number: | 5757488822 |
| NPI Enumeration Date: | 07/13/2005 |
| NPI Last Update Date: | 12/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/17/2006 |
| NPI Reactivation Date: | 03/29/2006 |
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: | |