Provider Demographics
NPI:1598121758
Name:SJMRK OFICINA MEDICA DRA MORENO CSP
Entity Type:Organization
Organization Name:SJMRK OFICINA MEDICA DRA MORENO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-627-6975
Mailing Address - Street 1:77 CALLE BETANCES
Mailing Address - Street 2:ESQUINA MUNOZ RIVERA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3514
Mailing Address - Country:US
Mailing Address - Phone:787-743-4077
Mailing Address - Fax:
Practice Address - Street 1:77 BETANCES ESQUINA MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-627-6975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care