Provider Demographics
NPI:1528363686
Name:MORENO, MARTA I (LND)
Entity Type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:I
Last Name:MORENO
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARITE # 209
Mailing Address - Street 2:CROWN HILLS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6008
Mailing Address - Country:US
Mailing Address - Phone:787-737-6441
Mailing Address - Fax:787-737-1280
Practice Address - Street 1:ANDRES ARUZ RIVERA 166 OESTE
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-6441
Practice Address - Fax:787-737-1288
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1538133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered