Basic Information
| Provider Information | |||||||||
| NPI: | 1659665297 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORENO-ORTA | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | LEBLANC | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEBLANC | ||||||||
| OtherFirstName: | CHRISTINE | ||||||||
| OtherMiddleName: | ROSE | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11130 CHRISTUS HILLS | ||||||||
| Address2: | 2ND FLOOR, SUITE 201 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107039001 | ||||||||
| FaxNumber: | 2107039155 | ||||||||
| Practice Location | |||||||||
| Address1: | 11130 CHRISTUS HILLS | ||||||||
| Address2: | MEDICAL PLAZA 3, 3RD FLOOR | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782513585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107039001 | ||||||||
| FaxNumber: | 2107039155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2011 | ||||||||
| LastUpdateDate: | 09/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | BP1-0040990 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | P6210 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3262446-02 | 05 | TX | MEDICAID |