Provider Demographics
NPI:1164736989
Name:MORALES, MARYNEZ EQUIHUA (RN)
Entity Type:Individual
Prefix:MS
First Name:MARYNEZ
Middle Name:EQUIHUA
Last Name:MORALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-1545
Mailing Address - Country:US
Mailing Address - Phone:619-518-9536
Mailing Address - Fax:
Practice Address - Street 1:2262 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-1545
Practice Address - Country:US
Practice Address - Phone:619-518-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 236012164X00000X
NY698786163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse