Provider Demographics
NPI:1699867507
Name:DELGADO MOURA, JANITZA (MD)
Entity type:Individual
Prefix:MRS
First Name:JANITZA
Middle Name:
Last Name:DELGADO MOURA
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:URB SANTA MARIA
Mailing Address - Street 2:CALLE NAZARET 7813
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-840-1053
Mailing Address - Fax:787-844-4189
Practice Address - Street 1:URB SANTA MARIA
Practice Address - Street 2:CALLE NAZARET 7813
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-840-1053
Practice Address - Fax:787-844-4189
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I46439Medicare UPIN