MEDICARE: BRYAN MORALES-VARGAS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1457804361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN MORALES-VARGAS

Provider Business Mailing Address
First Line	:	1049 CALLE 3 SE APT 301
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1049 CALLE 3 SE APT 301
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3001
Country	:	US
Telephone Number	:	787-423-9726
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	07/27/2016

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