Healthcare Provider Details

I. General information

NPI: 1174806335
Provider Name (Legal Business Name): MARLENE MORALES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 OLD LORENA RD
LORENA TX
76655-3176
US

IV. Provider business mailing address

5750 CURTIS CLARK DR APT 737
CORPUS CHRISTI TX
78412-4581
US

V. Phone/Fax

Practice location:
  • Phone: 757-642-5062
  • Fax:
Mailing address:
  • Phone: 210-705-3928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN9271
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: