Healthcare Provider Details

I. General information

NPI: 1821259367
Provider Name (Legal Business Name): MARIA DE LOS ANGELES MOYA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 CALLE TULIPAN
HATILLO PR
00659-2425
US

IV. Provider business mailing address

1051 CALLE TULIPAN
HATILLO PR
00659-2425
US

V. Phone/Fax

Practice location:
  • Phone: 787-399-9924
  • Fax:
Mailing address:
  • Phone: 787-399-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6489
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: