Healthcare Provider Details

I. General information

NPI: 1982251716
Provider Name (Legal Business Name): TATIANA MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URBANIZACION VILLA DEL MONTE MONTEFLORES 168
TOA ALTA PR
00953
US

IV. Provider business mailing address

URBANIZACION VILLA DEL MONTE MONTEFLORES 168
TOA ALTA PR
00953
US

V. Phone/Fax

Practice location:
  • Phone: 787-603-5273
  • Fax:
Mailing address:
  • Phone: 787-603-5273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6393
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: