Provider Demographics
NPI:1710437264
Name:DRA JANITZA R DELGADO MOURA L.L.C.
Entity Type:Organization
Organization Name:DRA JANITZA R DELGADO MOURA L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:JANITZA
Authorized Official - Middle Name:RAQUEL
Authorized Official - Last Name:DELGADO MOURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-342-1710
Mailing Address - Street 1:PO BOX 8097
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8097
Mailing Address - Country:US
Mailing Address - Phone:787-342-1710
Mailing Address - Fax:
Practice Address - Street 1:5 CALLE CONCEPCION
Practice Address - Street 2:
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656-1712
Practice Address - Country:US
Practice Address - Phone:787-835-0261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-08
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI46439Medicare UPIN