Healthcare Provider Details

I. General information

NPI: 1275425910
Provider Name (Legal Business Name): MARLYN MORALES ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 CALLE SALUD
PONCE PR
00717-2017
US

IV. Provider business mailing address

HC 4 BOX 7766
JUANA DIAZ PR
00795-9821
US

V. Phone/Fax

Practice location:
  • Phone: 787-228-0422
  • Fax:
Mailing address:
  • Phone: 787-228-0422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number6045
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: