Provider Demographics
NPI:1285190033
Name:MORALES, JUAN (LAC)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 WINFIELD BLVD APT 104
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7135
Mailing Address - Country:US
Mailing Address - Phone:954-815-9461
Mailing Address - Fax:
Practice Address - Street 1:6520 WINFIELD BLVD APT 104
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7135
Practice Address - Country:US
Practice Address - Phone:954-815-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4020171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist