Healthcare Provider Details

I. General information

NPI: 1144283789
Provider Name (Legal Business Name): YADIRA MORAN BETANCOURT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 02/21/2021
Certification Date: 02/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDF JESUS T PINERO
CAROLINA PR
00985
US

IV. Provider business mailing address

PO BOX 360708
SAN JUAN PR
00936-0708
US

V. Phone/Fax

Practice location:
  • Phone: 787-529-0443
  • Fax:
Mailing address:
  • Phone: 787-529-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14461
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: