Healthcare Provider Details

I. General information

NPI: 1629276951
Provider Name (Legal Business Name): OMAR MORALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2007
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE LOPATEGUI # 50 PARKVILLE PLAZA APT 105
GUAYNABO PR
00969-4595
US

IV. Provider business mailing address

AVE LOPATEGUI # 50 PARKVILLE PLAZA APT 105
GUAYNABO PR
00969-4595
US

V. Phone/Fax

Practice location:
  • Phone: 787-698-1213
  • Fax:
Mailing address:
  • Phone: 787-698-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number16912
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: