Provider Demographics
NPI:1053501122
Name:MORALES-MEDINA, ELBA IRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELBA
Middle Name:IRIS
Last Name:MORALES-MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELBA
Other - Middle Name:IRIS
Other - Last Name:MORALES DE ROMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14 CALLE PERAL N
Mailing Address - Street 2:OFICINA 1-E
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4861
Mailing Address - Country:US
Mailing Address - Phone:787-833-5544
Mailing Address - Fax:787-834-3446
Practice Address - Street 1:14 CALLE PERAL N
Practice Address - Street 2:OFICINA 1-E
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4861
Practice Address - Country:US
Practice Address - Phone:787-833-5544
Practice Address - Fax:787-834-3446
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3871208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics