Healthcare Provider Details

I. General information

NPI: 1245311737
Provider Name (Legal Business Name): PATRICIA ROSA MORENO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 AVE ESMERALDA URB.MUNOZ RIVERA
GUAYNABO PR
00969-4429
US

IV. Provider business mailing address

59 AVE ESMERALDA URB.MUNOZ RIVERA
GUAYNABO PR
00969-4429
US

V. Phone/Fax

Practice location:
  • Phone: 787-720-3234
  • Fax: 787-272-9729
Mailing address:
  • Phone: 787-720-3234
  • Fax: 787-272-9729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12315
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: