Provider Demographics
NPI:1083180418
Name:MORALES, ERICA (THL)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:THL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 URB LOS PROCERES
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-6076
Mailing Address - Country:US
Mailing Address - Phone:787-216-3304
Mailing Address - Fax:
Practice Address - Street 1:53 CALLE TAPIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911
Practice Address - Country:US
Practice Address - Phone:787-425-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist