Provider Demographics
NPI:1255152104
Name:MORENO, MARKUS RAY
Entity type:Individual
Prefix:
First Name:MARKUS
Middle Name:RAY
Last Name:MORENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 LOMA LINDA AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8505
Mailing Address - Country:US
Mailing Address - Phone:956-639-9244
Mailing Address - Fax:
Practice Address - Street 1:2117 E TYLER AVE STE B
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7212
Practice Address - Country:US
Practice Address - Phone:956-440-0580
Practice Address - Fax:956-428-0584
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218527224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant