1790934545 NPI number — FANNY ANDREA MORALES M.D.

Table of content: FANNY ANDREA MORALES M.D. (NPI 1790934545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790934545 NPI number — FANNY ANDREA MORALES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORALES
Provider First Name:
FANNY
Provider Middle Name:
ANDREA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORALES HYDER
Provider Other First Name:
FANNY
Provider Other Middle Name:
ANDREA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1790934545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1004 SOUTH ROCK STREET
Provider Second Line Business Mailing Address:
WESTLAKE ANESTHESIA GROUP, PA
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-279-0348
Provider Business Mailing Address Fax Number:
512-371-8788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5656 BEE CAVES RD
Provider Second Line Business Practice Location Address:
SUITE M-302
Provider Business Practice Location Address City Name:
WEST LAKE HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-5280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-697-3502
Provider Business Practice Location Address Fax Number:
512-697-3501
Provider Enumeration Date:
09/17/2008

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: 207L00000X , with the licence number:  Q0981 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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