Healthcare Provider Details

I. General information

NPI: 1063402329
Provider Name (Legal Business Name): ARIEL F MORCIGLIO SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CALLE ANGEL R MORA
JUANA DIAZ PR
00795-1617
US

IV. Provider business mailing address

PO BOX 442
GUANICA PR
00653-0442
US

V. Phone/Fax

Practice location:
  • Phone: 787-260-4887
  • Fax: 787-260-4887
Mailing address:
  • Phone: 787-260-4887
  • Fax: 787-260-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12366
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: