Provider Demographics
NPI:1720042054
Name:MORENO, LUIS E (MD)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:E
Last Name:MORENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 NO CIUDAD JARDIN III
Mailing Address - Street 2:GRAN AUSUBO ST
Mailing Address - City:TOA ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00953-4886
Mailing Address - Country:US
Mailing Address - Phone:787-799-0604
Mailing Address - Fax:
Practice Address - Street 1:LAS FLORES ST 76 NO
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962
Practice Address - Country:US
Practice Address - Phone:787-788-2770
Practice Address - Fax:787-275-0855
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12374208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR500134EOtherMMM
PR500134EOtherMMM