Healthcare Provider Details

I. General information

NPI: 1518957281
Provider Name (Legal Business Name): ANNA VICTORIA MORALES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6923 WESTCOTT PL
CLARKSVILLE MD
21029-1710
US

IV. Provider business mailing address

5995 OPUS PKWY SUITE 200
MINNETONKA MN
55343-8387
US

V. Phone/Fax

Practice location:
  • Phone: 952-392-1100
  • Fax: 952-935-2757
Mailing address:
  • Phone: 952-595-1220
  • Fax: 952-935-2757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0058092
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: