Healthcare Provider Details

I. General information

NPI: 1609176593
Provider Name (Legal Business Name): MRS. MARTA MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO MACHUELO TERRENOS HOSPITAL SAN LUCAS II FINAL
PONCE PR
00730
US

IV. Provider business mailing address

PO BOX 401
COAMO PR
00769-0401
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-6630
  • Fax: 787-844-4130
Mailing address:
  • Phone:
  • Fax: 787-844-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number15889
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: