MEDICARE: RICARDO YAMIL MORALES CORA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	473	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C19666250	OTHER	PR	NURSING HOME OWNER

General Provider Information

NPI Number	:	1982201224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO YAMIL MORALES CORA

Provider Business Mailing Address
First Line	:	URB VILLA ANDALUCIA
Second Line	:	M-19 CALLE FRONTERA
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-667-2289
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB VILLA ANDALUCIA
Second Line	:	M-19 CALLE FRONTERA
City	:	SAN JUAN
State	:	PR
Zip	:	00926-0092
Country	:	US
Telephone Number	:	787-667-2289
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	10/08/2020

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