Healthcare Provider Details

I. General information

NPI: 1881797207
Provider Name (Legal Business Name): NANCY MORALES-RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PASEO DEL VETERANO
PONCE PR
00716-2001
US

IV. Provider business mailing address

ST 16 S 14 URB LOMAS DE COUNTRY CLUB
PONCE PR
00730
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3030
  • Fax:
Mailing address:
  • Phone: 787-400-2743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16347
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: