1265656235 NPI number — MRS. GLORIA MORALES MD

Table of content: MRS. GLORIA MORALES MD (NPI 1265656235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265656235 NPI number — MRS. GLORIA MORALES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORALES
Provider First Name:
GLORIA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1265656235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4952
Provider Second Line Business Mailing Address:
PMB 474
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-4952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-744-8645
Provider Business Mailing Address Fax Number:
787-746-2898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB. MANSIONES DEL PARAISO #35
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-744-8645
Provider Business Practice Location Address Fax Number:
787-746-2898
Provider Enumeration Date:
04/12/2007

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: 208D00000X , with the licence number:  10954 , 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: DM104992 . This is a "ESTATAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: BM3479258 . This is a "FEDERAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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