Healthcare Provider Details

I. General information

NPI: 1780153197
Provider Name (Legal Business Name): GABRIEL JOSE MORA OSORIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEL NORTE PROFESSIONAL CENTER OFICINA 303,CARR 493 BO. CARRIZALES
HATILLO PR
00659
US

IV. Provider business mailing address

HC 6 BOX 10170
HATILLO PR
00659-6624
US

V. Phone/Fax

Practice location:
  • Phone: 787-567-9122
  • 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 Number21155
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: