Provider Demographics
NPI:1609860535
Name:LANDRAU MORENO, MORAIMA (MD)
Entity Type:Individual
Prefix:
First Name:MORAIMA
Middle Name:
Last Name:LANDRAU 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:PO BOX 7142
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7142
Mailing Address - Country:US
Mailing Address - Phone:787-840-7780
Mailing Address - Fax:787-840-7780
Practice Address - Street 1:1136 AVE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0643
Practice Address - Country:US
Practice Address - Phone:787-840-7780
Practice Address - Fax:787-840-7780
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3911208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
D33449Medicare UPIN
PR24744Medicare ID - Type Unspecified