Healthcare Provider Details

I. General information

NPI: 1356890099
Provider Name (Legal Business Name): NIURKA MORENO PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G112 CALLE AMBAR URB COSTA BRAVA
ISABELA PR
00662
US

IV. Provider business mailing address

G112 CALLE AMBAR URB COSTA BRAVA
ISABELA PR
00662
US

V. Phone/Fax

Practice location:
  • Phone: 787-941-5409
  • Fax:
Mailing address:
  • Phone: 787-941-5409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2102
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: