Healthcare Provider Details

I. General information

NPI: 1255068185
Provider Name (Legal Business Name): AIXA G MORALES QUINONES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA ROBERTO CLEMENTE BLOQUE 124 #8 VILLA CAROLINA
CAROLINA PR
00985
US

IV. Provider business mailing address

PO BOX 3628
CAROLINA PR
00984-3628
US

V. Phone/Fax

Practice location:
  • Phone: 787-750-4920
  • Fax:
Mailing address:
  • Phone: 787-750-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22882
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: