Provider Demographics
NPI:1447709134
Name:MORALES, MIRIAM
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8011776
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1176
Mailing Address - Country:US
Mailing Address - Phone:787-844-5788
Mailing Address - Fax:
Practice Address - Street 1:CARR 14 KM 122
Practice Address - Street 2:BARRIO COTO LAUREL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00780-1176
Practice Address - Country:US
Practice Address - Phone:787-844-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR824291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory