Healthcare Provider Details

I. General information

NPI: 1982600250
Provider Name (Legal Business Name): CARLOS MANUEL MORALES PAGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A7 CALLE ACOSTA URB VILLA MARIA
MANATI PR
00674-4933
US

IV. Provider business mailing address

PO BOX 488
MANATI PR
00674-0488
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-5946
  • Fax: 787-884-4461
Mailing address:
  • Phone: 787-884-5946
  • Fax: 787-884-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number7768
License Number StatePR

VII. Legacy identifiers

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

# 1
Identifier038442600
Identifier TypeMEDICAID
Identifier StatePR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: