Healthcare Provider Details

I. General information

NPI: 1508786294
Provider Name (Legal Business Name): ANTONIO DE JESUS MORALES MONTALVO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVE. LAUREL, SANTA JUANITA, BAYAMON, PR 00956
BAYAMON PR
00956
US

IV. Provider business mailing address

PASEO LOS CORALES II CALLE MAR DEL NORTE 761 DORADO PR 00646
DORADO PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-3001
  • Fax:
Mailing address:
  • Phone: 787-329-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: