1376307587 NPI number — WILLIAM ALFONSO MORALES RODRIGUEZ

Table of content: WILLIAM ALFONSO MORALES RODRIGUEZ (NPI 1376307587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376307587 NPI number — WILLIAM ALFONSO MORALES RODRIGUEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORALES RODRIGUEZ
Provider First Name:
WILLIAM
Provider Middle Name:
ALFONSO
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1376307587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 5 BOX 9416
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIO GRANDE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00745-9351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-909-7366
Provider Business Mailing Address Fax Number:
787-256-5284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CONDOMINIO PARK VIEW TERRACE
Provider Second Line Business Practice Location Address:
EDIFICIO 10 APARTAMENTO 301
Provider Business Practice Location Address City Name:
CANOVANAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-909-7366
Provider Business Practice Location Address Fax Number:
787-256-5284
Provider Enumeration Date:
02/08/2024

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: 172A00000X , with the licence number:  4314820 , 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)





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