Healthcare Provider Details

I. General information

NPI: 1851662662
Provider Name (Legal Business Name): JONATHAN MORALES GONZALEZ TML,NL.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 06/22/2017
Certification Date: MORALES GONZALEZ JONATHAN 451 CALLE DEL PILAR MOCA PR 00676 451 CALLE DEL PILAR MOCA PR 00676
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CALLE DEL PILAR URB LA MONSERRATE
MOCA PR
00676-4312
US

IV. Provider business mailing address

451 CALLE DEL PILAR URB LA MONSERRATE
MOCA PR
00676-4312
US

V. Phone/Fax

Practice location:
  • Phone: 787-533-3485
  • Fax:
Mailing address:
  • Phone: 787-533-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number4818324
License Number StateZZ
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0653
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: