Active NPI
Ethan Moreno
- Speech-Language Assistant
- Corpus Christi, TX
National Provider Identifier
1548630601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Assistant
- License
- 38714
- Practice address
- 4444 Corona Dr
Ste. 234
Corpus Christi, TX 78411-4324 - Phone
- (361) 854-1110
- Fax
- (855) 448-9769
- NPI assigned
- Oct 1, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Assistant | 2355S0801X | 38714 | TX | Primary |
Addresses
Primary practice location
4444 Corona Dr
Ste. 234
Corpus Christi, TX 78411-4324
Mailing address
4444 Corona Dr
Ste. 234
Corpus Christi, TX 78411-4324
Phone (361) 854-1110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38714 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443657600000",
"number": "1548630601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4444 CORONA DR",
"address_2": "STE. 234",
"city": "CORPUS CHRISTI",
"state": "TX",
"postal_code": "784114324",
"telephone_number": "361-854-1110",
"fax_number": "855-448-9769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4444 CORONA DR",
"address_2": "STE. 234",
"city": "CORPUS CHRISTI",
"state": "TX",
"postal_code": "784114324",
"telephone_number": "361-854-1110",
"fax_number": "855-448-9769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "ETHAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-01",
"last_updated": "2015-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "TX",
"license": "38714",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corpus Christi, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.