Healthcare Provider Details

I. General information

NPI: 1982201224
Provider Name (Legal Business Name): RICARDO YAMIL MORALES CORA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VILLA ANDALUCIA M-19 CALLE FRONTERA
SAN JUAN PR
00926-0092
US

IV. Provider business mailing address

URB VILLA ANDALUCIA M-19 CALLE FRONTERA
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-667-2289
  • Fax:
Mailing address:
  • Phone: 787-667-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number473
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: