Healthcare Provider Details

I. General information

NPI: 1336218700
Provider Name (Legal Business Name): EDNA M MORA PINERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 CALLE DUKE
SAN JUAN PR
00927-4120
US

IV. Provider business mailing address

261 CALLE DUKE
SAN JUAN PR
00927-4120
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-1240
  • Fax: 787-758-8304
Mailing address:
  • Phone: 787-274-1908
  • Fax: 787-274-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number9324
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: