=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851647689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MORALES GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2012
-----------------------------------------------------
Last Update Date | 07/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 314 E NAKOMA ST STE A
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78216-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-338-0530
-----------------------------------------------------
Fax | 210-338-8510
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 314 E NAKOMA ST STE A
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78216-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-338-0530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/OWNER
-----------------------------------------------------
Name | REINALDO MORALES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 210-338-0530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | N4597
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------