Healthcare Provider Details

I. General information

NPI: 1073567855
Provider Name (Legal Business Name): ALEXIS VLADIMIR MORALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO MONACILLO CARRETERA #22, PASEO DR. JOSE C. BARBOSA
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

COND MIRAMAR PLZ PONCE DE LEON 954
SAN JUAN PR
00907-3646
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3760
  • Fax:
Mailing address:
  • Phone: 787-724-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15053
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: