1083828040 NPI number — DR. DAVID MORALES-ORTA M.D.

Table of content: DR. DAVID MORALES-ORTA M.D. (NPI 1083828040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083828040 NPI number — DR. DAVID MORALES-ORTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORALES-ORTA
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1083828040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
229 CARR #2 PHA VILLA CAPARRA EXECUTIVE COND
Provider Second Line Business Mailing Address:
PHA VILLA CAPARRA EXECUTIVE COND.
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00966-6541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-785-0473
Provider Business Mailing Address Fax Number:
787-740-0080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
62 CALLE GEORGETTI
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00925-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-754-1980
Provider Business Practice Location Address Fax Number:
787-754-8202
Provider Enumeration Date:
05/09/2007

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: 2085R0202X , with the licence number:  4172 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085U0001X , with the licence number: 4172 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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