MEDICARE: MORZAK HEALTH CARE SERVICES CSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	11668	PR

General Provider Information

NPI Number	:	1154534865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORZAK HEALTH CARE SERVICES CSP

Provider Business Mailing Address
First Line	:	P.O. BOX 9021
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00988-0000
Country	:	US
Telephone Number	:	787-769-4034
Fax Number	:	787-768-8565

Provider Business Practice Location Address
First Line	:	VALLE ARRIBA HEIGHTS
Second Line	:	AVE. FIDALGO DIAZ ESQ. AA5
City	:	CAROLINA
State	:	PR
Zip	:	00983-0000
Country	:	US
Telephone Number	:	787-769-4034
Fax Number	:	787-768-8565

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. KHADIJAH A. HAMDALLAH
Credential	:	M.D.
Telephone Number	:	787-769-4034

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	10/12/2012

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