Provider Demographics
NPI:1568610673
Name:MORENO, DALMARYS (MD)
Entity Type:Individual
Prefix:
First Name:DALMARYS
Middle Name:
Last Name:MORENO
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:HC03 BOX 17363
Mailing Address - Street 2:BO. NEGROS
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-9817
Mailing Address - Country:US
Mailing Address - Phone:787-516-5734
Mailing Address - Fax:787-859-2596
Practice Address - Street 1:CALLE MARINA # 6
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-1062
Practice Address - Fax:787-859-2596
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11231I363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17283OtherDRIVER LISCENCE NUM. 4108049