Provider Demographics
NPI:1316015761
Name:DE LA MORENA, MARIA LUISA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LUISA
Last Name:DE LA MORENA
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 1:1600 HARRISON AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3145
Mailing Address - Country:US
Mailing Address - Phone:914-777-6600
Mailing Address - Fax:914-777-6602
Practice Address - Street 1:1600 HARRISON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3145
Practice Address - Country:US
Practice Address - Phone:914-777-6600
Practice Address - Fax:914-777-6602
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223610208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics