Healthcare Provider Details

I. General information

NPI: 1275121311
Provider Name (Legal Business Name): RACHEL MARIE MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 E COMMERCIAL BLVD STE 202
FORT LAUDERDALE FL
33308-3754
US

IV. Provider business mailing address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-202-7850
  • Fax:
Mailing address:
  • Phone: 954-262-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116434
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: