Provider Demographics
NPI:1467433615
Name:MORA, MAYRA DEL CARMEN DELGADO (MD)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA DEL CARMEN
Middle Name:DELGADO
Last Name:MORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MORA
Other - Middle Name:DELGADO
Other - Last Name:MAYRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 142961
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-2961
Mailing Address - Country:US
Mailing Address - Phone:787-855-1163
Mailing Address - Fax:787-855-1163
Practice Address - Street 1:EDIFICIO GARVEL QUENIDA MILITAR
Practice Address - Street 2:#2913 STE 1
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4078
Practice Address - Country:US
Practice Address - Phone:787-830-0222
Practice Address - Fax:787-830-0225
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14903208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
21966MDOtherSSS
21966MDOtherSSS
0021966Medicare ID - Type Unspecified