Provider Demographics
NPI:1366176539
Name:MORENO QUINONEZ, THALIA (RBT)
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:
Last Name:MORENO QUINONEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12330 PELLICANO DRIVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-1443
Mailing Address - Country:US
Mailing Address - Phone:915-701-2845
Mailing Address - Fax:
Practice Address - Street 1:12230 PELICANO DR.
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7993
Practice Address - Country:US
Practice Address - Phone:915-701-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician