Provider Demographics
NPI:1144737255
Name:MORALES LOPEZ, KARLA CORAL
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:CORAL
Last Name:MORALES LOPEZ
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 488
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0488
Mailing Address - Country:US
Mailing Address - Phone:787-883-3739
Mailing Address - Fax:787-883-3827
Practice Address - Street 1:11 JAIME ACOSTA ST
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-3739
Practice Address - Fax:787-883-3827
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19812208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice