Healthcare Provider Details

I. General information

NPI: 1598829244
Provider Name (Legal Business Name): LUIS A. MORALES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3178 CALLE CRESTA
TOA BAJA PR
00949-3130
US

IV. Provider business mailing address

3178 CALLE CRESTA
TOA BAJA PR
00949-3130
US

V. Phone/Fax

Practice location:
  • Phone: 787-261-1298
  • Fax:
Mailing address:
  • Phone: 787-261-1298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC22023
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number835
License Number StatePR

VIII. Authorized Official

Name: MRS. LORNA TORRES
Title or Position: CLINICAL DIRECTOR
Credential: OT
Phone: 787-261-1298