Provider Demographics
NPI:1194390427
Name:MORALES, JIVET LEE
Entity Type:Individual
Prefix:
First Name:JIVET
Middle Name:LEE
Last Name:MORALES
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:URBANIZACION ESTANCIAS DE JUNCOS
Mailing Address - Street 2:CALLE CAMINO DEL PARQUE 112
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777
Mailing Address - Country:US
Mailing Address - Phone:939-276-1574
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION ESTANCIAS DE JUNCOS
Practice Address - Street 2:CALLE CAMINO DEL PARQUE 112
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:939-276-1574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23059208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice