Healthcare Provider Details

I. General information

NPI: 1700860566
Provider Name (Legal Business Name): DR. SONNY H MORETTA CABRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ED MEDICO PROF. 211 AVE. LOS CORAZONES 1065
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

ED MEDICO PROF. 211 AVE. LOS CORAZONES 1065
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-9376
  • Fax:
Mailing address:
  • Phone: 787-833-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number5347
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: