Provider Demographics
NPI:1346349917
Name:MORALES, JOHARA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHARA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 509
Mailing Address - Street 2:P.O.BOX 7891
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-7891
Mailing Address - Country:US
Mailing Address - Phone:787-789-1919
Mailing Address - Fax:787-789-1921
Practice Address - Street 1:1 AVE CASA LINDA STE 101
Practice Address - Street 2:ENTRADA AMERICAN MILITARY ACADEMY
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-8998
Practice Address - Country:US
Practice Address - Phone:787-789-1919
Practice Address - Fax:787-789-1921
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR140372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH23161Medicare UPIN
PR20939Medicare ID - Type Unspecified