Healthcare Provider Details

I. General information

NPI: 1578931614
Provider Name (Legal Business Name): RYANN MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2015
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 KENNEDY ST
ALEXANDRIA VA
22305-2517
US

IV. Provider business mailing address

7011 CALAMO ST STE 204
SPRINGFIELD VA
22150-3510
US

V. Phone/Fax

Practice location:
  • Phone: 202-258-0085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: