Healthcare Provider Details

I. General information

NPI: 1447881883
Provider Name (Legal Business Name): ALYSSA NICOLE MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 GATEWAY BLVD W
EL PASO TX
79925-7701
US

IV. Provider business mailing address

1816 TOM BOLT DR
EL PASO TX
79936-4218
US

V. Phone/Fax

Practice location:
  • Phone: 915-263-5000
  • Fax:
Mailing address:
  • Phone: 915-269-6823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP146042
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number797702
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: