Healthcare Provider Details

I. General information

NPI: 1659988376
Provider Name (Legal Business Name): JENNIFER MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2020
Last Update Date: 09/27/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 SE 1ST ST APT 6
POMPANO BEACH FL
33060-7352
US

IV. Provider business mailing address

902 SE 1ST ST APT 6
POMPANO BEACH FL
33060-7352
US

V. Phone/Fax

Practice location:
  • Phone: 781-558-7455
  • Fax:
Mailing address:
  • Phone: 781-558-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: