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General NPI Number Information
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NPI Number | 1679723084
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Entity Type | Individual
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Provider Name | LAURA MARIA MORALES PA - C
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Gender | Female
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 19829 N 27TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85027-4001
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Country | US
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Telephone | 623-879-5288
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Fax | 623-879-1563
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Provider Business Mailing Address
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Address Line | 3655 W ANTHEM WAY STE A109
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City | ANTHEM
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State | AZ
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Zip | 85086-0430
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Country | US
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Telephone | 623-879-5288
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Fax | 623-879-1563
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4277
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License Number State | AZ
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