Provider Demographics
NPI:1265493589
Name:GOSS, MORAIMA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MORAIMA
Middle Name:M
Last Name:GOSS
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:EL PARAISO FLORAL COURT
Mailing Address - Street 2:AVE. PARANA TH 3
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-754-5993
Mailing Address - Fax:
Practice Address - Street 1:EL PARAISO FLORAL COURT
Practice Address - Street 2:AVE. PARANA TH 3
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-754-5993
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13985208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH68438Medicare UPIN
SC0084339Medicare ID - Type Unspecified