Provider Demographics
NPI:1356659510
Name:MORENO CAMPA, MARYANGELY E (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARYANGELY
Middle Name:E
Last Name:MORENO CAMPA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:AVENIDA FELISA RINCON DE GAUTIER
Mailing Address - Street 2:CONDOMINIO PASEO MONTE 1002
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-640-6232
Mailing Address - Fax:787-848-0318
Practice Address - Street 1:MAYAGUEZ MEDICAL EMPORIUM II, SUITE A-15
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-831-6429
Practice Address - Fax:787-848-0318
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2019-01-02
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Provider Licenses
StateLicense IDTaxonomies
PR27910207R00000X
PR020759207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHP687AMedicare PIN