Healthcare Provider Details

I. General information

NPI: 1477436764
Provider Name (Legal Business Name): MORA ENDOCRINOLOGY AND DIABETES CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 07/26/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEL NORTE PROFESSIONAL CENTER OFICINA 303 CARR 493 BO CARRIZALES KM 0.9
HATILLO PR
00659
US

IV. Provider business mailing address

CONDOMINIO PARQUE CENTRO ALEU C28 170 AVE ARTERIAL AV H
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-224-4902
  • Fax:
Mailing address:
  • Phone: 787-567-9122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GABRIEL MORA OSORIA
Title or Position: OWNER
Credential: MD
Phone: 787-567-9122