Healthcare Provider Details

I. General information

NPI: 1043137474
Provider Name (Legal Business Name): JUAN ALBERTO MORENO PADILLA NL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 167 ESQ CALLE PARQUE LOCAL 10
BAYAMON PR
00960
US

IV. Provider business mailing address

PO BOX 615
COROZAL PR
00783-0615
US

V. Phone/Fax

Practice location:
  • Phone: 787-649-9593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number173
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: