Healthcare Provider Details

I. General information

NPI: 1053501122
Provider Name (Legal Business Name): ELBA IRIS MORALES-MEDINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELBA IRIS MORALES DE ROMAN MD

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CALLE PERAL N OFICINA 1-E
MAYAGUEZ PR
00680-4861
US

IV. Provider business mailing address

14 CALLE PERAL N OFICINA 1-E
MAYAGUEZ PR
00680-4861
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-5544
  • Fax: 787-834-3446
Mailing address:
  • Phone: 787-833-5544
  • Fax: 787-834-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3871
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: