Healthcare Provider Details

I. General information

NPI: 1003484262
Provider Name (Legal Business Name): MORA MOBILE X RAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 05/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA DEL CARMEN CALLE TOLEDO 2707
PONCE PR
00716
US

IV. Provider business mailing address

VILLA DEL CARMEN CALLE TOLEDO 2707
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-486-1512
  • Fax:
Mailing address:
  • Phone: 787-486-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL MORA VAZQUEZ
Title or Position: PRESIDENT
Credential: RT
Phone: 787-486-1512