Healthcare Provider Details

I. General information

NPI: 1871429589
Provider Name (Legal Business Name): CARLOS MORALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4299 E NEBRASKA LN
HERNANDO FL
34442-5615
US

IV. Provider business mailing address

4299 E NEBRASKA LN
HERNANDO FL
34442-5615
US

V. Phone/Fax

Practice location:
  • Phone: 352-586-2685
  • Fax:
Mailing address:
  • Phone: 352-586-2685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: