Doctor Name: | MR. LUIS E MORENO |
NPI Number: | 1720042054 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 12374 |
Business Practice Address: | Las Flores St 76 No Catano, PR - 00962 |
Business Phone Number: | 7877882770 |
Business Fax Number: | 7872750855 |
Mailing Address: | 389 No Ciudad Jardin Iii, Gran Ausubo St TOA ALTO |
State: | PR |
Postal Code: | 009534886 |
Phone Number: | 7877990604 |
Fax Number: | |
NPI Enumeration Date: | 04/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 12374 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |