Provider Demographics
NPI:1073567855
Name:MORALES, ALEXIS VLADIMIR (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:VLADIMIR
Last Name:MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND MIRAMAR PLZ
Mailing Address - Street 2:PONCE DE LEON 954
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3646
Mailing Address - Country:US
Mailing Address - Phone:787-724-4406
Mailing Address - Fax:
Practice Address - Street 1:BARRIO MONACILLO
Practice Address - Street 2:CARRETERA #22, PASEO DR. JOSE C. BARBOSA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-777-3760
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15053208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice