Healthcare Provider Details

I. General information

NPI: 1912064494
Provider Name (Legal Business Name): IBIS MORALES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IBIS MORALES-MONTALVO M.D.

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JARDINES DE BAYAMONTE 85 CALLE GORRION
BAYAMON PR
00956-6639
US

IV. Provider business mailing address

JARDINES DE BAYAMONTE 85 CALLE GORRION
BAYAMON PR
00956-6639
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-1742
  • Fax: 787-740-1742
Mailing address:
  • Phone: 787-740-1742
  • Fax: 787-740-1742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8588
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: