Healthcare Provider Details

I. General information

NPI: 1467568725
Provider Name (Legal Business Name): VICTOR MORENO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MUNOZ RIVERA # 15
MAUNABO PR
00707
US

IV. Provider business mailing address

URB. PACIFICA ENCANTADA VIA HORIZONTE PG-69
TRUJILLO ALTO PR
00976
US

V. Phone/Fax

Practice location:
  • Phone: 787-392-7784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number6339
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: