Healthcare Provider Details

I. General information

NPI: 1215904651
Provider Name (Legal Business Name): MICHELLE MORINGLANE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 2 BOX 13066
GURABO PR
00778-9615
US

IV. Provider business mailing address

HC 2 BOX 13066
GURABO PR
00778-9615
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-4289
  • Fax: 787-743-4289
Mailing address:
  • Phone: 787-743-4289
  • Fax: 787-743-4289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13537
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: