Provider Demographics
NPI:1871917328
Name:MORALES, PABLO ANTONIO SR
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:ANTONIO
Last Name:MORALES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:I29 CALLE VIOLETA
Mailing Address - Street 2:REPTO VALENCIA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-4141
Mailing Address - Country:US
Mailing Address - Phone:787-462-5062
Mailing Address - Fax:
Practice Address - Street 1:I29 CALLE VIOLETA
Practice Address - Street 2:REPTO VALENCIA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-4141
Practice Address - Country:US
Practice Address - Phone:787-462-5062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR735156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician