Healthcare Provider Details

I. General information

NPI: 1740509272
Provider Name (Legal Business Name): MRS. LISA M MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 CALLE POMAROSA IMBERY
BARCELONETA PR
00617
US

IV. Provider business mailing address

CARR 2 CALLE POMAROSA IMBERY
BARCELONETA PR
00617
US

V. Phone/Fax

Practice location:
  • Phone: 787-485-6522
  • Fax:
Mailing address:
  • Phone: 787-485-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number7468
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4608881
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerDRIVER LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: