Healthcare Provider Details

I. General information

NPI: 1417198698
Provider Name (Legal Business Name): ESPERANZA G. MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 CERRADO SANCHEZ
RIO RICO AZ
85648-2825
US

IV. Provider business mailing address

922 CERRADO SANCHEZ
RIO RICO AZ
85648-2825
US

V. Phone/Fax

Practice location:
  • Phone: 520-721-1887
  • Fax: 520-407-5398
Mailing address:
  • Phone: 520-358-7061
  • Fax: 520-407-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number432869
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: