Provider Demographics
NPI:1669593067
Name:NEGRON, MORAIMA DE LOURDES (OD)
Entity type:Individual
Prefix:DR
First Name:MORAIMA
Middle Name:DE LOURDES
Last Name:NEGRON
Suffix:
Gender:F
Credentials:OD
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 192173
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2173
Mailing Address - Country:US
Mailing Address - Phone:787-505-1184
Mailing Address - Fax:
Practice Address - Street 1:60 CALLE GEORGETTI
Practice Address - Street 2:STE 1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3607
Practice Address - Country:US
Practice Address - Phone:787-765-0039
Practice Address - Fax:787-765-0039
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR588152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist