Provider Demographics
NPI:1144276817
Name:MORENO, MILAGROS (MD)
Entity type:Individual
Prefix:MRS
First Name:MILAGROS
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-743-4077
Mailing Address - Fax:787-743-4077
Practice Address - Street 1:AVE MUNOZ RIVERA
Practice Address - Street 2:#4
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-4077
Practice Address - Fax:787-743-4077
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8611208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80160Medicare ID - Type Unspecified
E80038Medicare UPIN