MEDICARE: JUAN CARLOS MORALES

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	3104A0625X	Assisted Living Facility (Mental Illness)	AL7679	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912340506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN CARLOS MORALES

Provider Business Mailing Address
First Line	:	158 W 10TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4007
Country	:	US
Telephone Number	:	786-600-8679
Fax Number	:	786-362-6157

Provider Business Practice Location Address
First Line	:	158 W 10TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4007
Country	:	US
Telephone Number	:	786-600-8679
Fax Number	:	786-362-6157

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

Provider Enumeration Date	:	04/12/2013
Last Update Date	:	04/12/2013

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Directions to “ JUAN CARLOS MORALES ” Practice Location

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