Juan D Moreno, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2017021 Issued in NM

Practice address

221 3Rd St W BLDG 1040
Jbsa Randolph, TX 78150-4800

Phone

(210) 652-6550

Fax

(210) 292-4130

NPI assigned

Jan 23, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1447640842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 3RD ST W BLDG 1040",
            "city": "JBSA RANDOLPH",
            "state": "TX",
            "postal_code": "781504800",
            "telephone_number": "210-652-6550",
            "fax_number": "210-292-4130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 3RD ST W BLDG 1040",
            "city": "JBSA RANDOLPH",
            "state": "TX",
            "postal_code": "781504800",
            "telephone_number": "210-652-6550",
            "fax_number": "210-292-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO",
        "first_name": "JUAN",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-23",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2017021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deanne Villarreal Martinez, P.A.
• Joyce Debora Mason, RN
• Andrew Stuntz McCampbell, PA-C, DMSC
• Jacqueline Mills, JACQUELINE MILLS
• Milton R Miranda Rosa, MD
• Angela Nance, LCSW
• John Yoonsik Oh, MD
• Alexander Scott Patlovany, PHARMD
• Andrew Pellegrin, MD
• Tere Penland, APRN, CPNP-PC

• Physician Assistant in Jbsa Randolph, TX
• Providers in Jbsa Randolph, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.