1093146102 NPI number — RICARDO OLIVERAS MORALES

Table of content: TERRY LYNN HAFER D.C. (NPI 1093920936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093146102 NPI number — RICARDO OLIVERAS MORALES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICARDO OLIVERAS MORALES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1093146102
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 3 BOX 15234
Provider Second Line Business Mailing Address:
BO. JACAGUAS
Provider Business Mailing Address City Name:
JUANA DIAZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00795-9858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-204-9733
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HC 3 BOX 15234
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUANA DIAZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00795-9858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-204-9733
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OLIVERAS
Authorized Official First Name:
RICARDO
Authorized Official Middle Name:
Authorized Official Title or Position:
TRABAJADOR SOCIAL
Authorized Official Telephone Number:
787-204-9733

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  19317 , 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)