1750520102 NPI number — MR. CARLOS A MORALES ALICEA SR.

Table of content: MR. CARLOS A MORALES ALICEA SR. (NPI 1750520102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750520102 NPI number — MR. CARLOS A MORALES ALICEA SR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORALES ALICEA
Provider First Name:
CARLOS
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750520102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 073 PO BOX 8901
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATILLO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00659-8901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-820-3198
Provider Business Mailing Address Fax Number:
787-820-3198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 130 KM 10.3 INT
Provider Second Line Business Practice Location Address:
BO CAMPO ALEGRE
Provider Business Practice Location Address City Name:
HATILLO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00659-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-820-3198
Provider Business Practice Location Address Fax Number:
787-820-3198
Provider Enumeration Date:
02/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  TP161 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TP161 . This is a "TP 161 BILLING NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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