Healthcare Provider Details

I. General information

NPI: 1245627314
Provider Name (Legal Business Name): LORENA D. MORALES-CONCEPCION MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 CALLE PEDRO ROSARIO
AIBONITO PR
00705-3237
US

IV. Provider business mailing address

PO BOX 6628
CAGUAS PR
00726-6628
US

V. Phone/Fax

Practice location:
  • Phone: 787-961-0760
  • Fax:
Mailing address:
  • Phone: 787-746-7441
  • Fax: 787-746-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number19802
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: