Healthcare Provider Details

I. General information

NPI: 1760421226
Provider Name (Legal Business Name): DR. NOEL RODERICK MORALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CALLE TULIO OTERO
VEGA BAJA PR
00693-4343
US

IV. Provider business mailing address

PO BOX 4035
VEGA BAJA PR
00694-4035
US

V. Phone/Fax

Practice location:
  • Phone: 787-855-5963
  • Fax: 787-855-5963
Mailing address:
  • Phone: 787-854-6462
  • Fax: 787-854-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VC0200X
TaxonomyCritical Care Medicine (Obstetrics & Gynecology) Physician
License Number04132DM-7
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: