Healthcare Provider Details

I. General information

NPI: 1598881864
Provider Name (Legal Business Name): ILIANA TORRES-MOJICA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 CALLE CESAR GONZALEZ APT 3704 CONDOMINIO PLAZA ANTILLANA
SAN JUAN PR
00918-5112
US

IV. Provider business mailing address

151 CALLE CESAR GONZALEZ APT 3704 CONDOMINIO PLAZA ANTILLANA
SAN JUAN PR
00918-5112
US

V. Phone/Fax

Practice location:
  • Phone: 787-398-5888
  • Fax: 787-774-6251
Mailing address:
  • Phone: 787-398-5888
  • Fax: 787-774-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14899
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: