Provider Demographics
NPI:1215189113
Name:MORO, YADIRA
Entity type:Individual
Prefix:MRS
First Name:YADIRA
Middle Name:
Last Name:MORO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:# 205 TRINITARIA ST. URB MANUEL CORCHADO
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0000
Mailing Address - Country:US
Mailing Address - Phone:939-579-8013
Mailing Address - Fax:
Practice Address - Street 1:205 CALLE TRINITARIA
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2739
Practice Address - Country:US
Practice Address - Phone:939-579-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1522133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered