Healthcare Provider Details

I. General information

NPI: 1730079690
Provider Name (Legal Business Name): JIPSI MARIE JAIME MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SECTOR CUESTA LOS JOBOS
HUMACAO PR
00791
US

IV. Provider business mailing address

CENTRAL PARKS APARTMENTS OF SAN JUAN EDIF D , APARTAMENTO D6
SAN JUAN PR
00909
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-0756
  • Fax:
Mailing address:
  • Phone: 939-216-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25185
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: