Provider Demographics
NPI:1225616022
Name:MORALES, JUAN RICARDO SR
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:RICARDO
Last Name:MORALES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PALMA DORADA VILLAGE
Mailing Address - Street 2:EDIF J APT 1903
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-779-9524
Mailing Address - Fax:
Practice Address - Street 1:PALMA DORADA VILLAGE
Practice Address - Street 2:EDIF J APT 1903
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-779-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1667239172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver