Provider Demographics
NPI:1346559325
Name:MORALES, MIGUEL ANGEL (INDEPENDENT DUTY HM)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:MORALES
Suffix:
Gender:M
Credentials:INDEPENDENT DUTY HM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35000 GUADACANAL STREET
Mailing Address - Street 2:BRANCH MEDICAL CLINIC (MCRD)
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92140
Mailing Address - Country:US
Mailing Address - Phone:619-524-4045
Mailing Address - Fax:
Practice Address - Street 1:35000 GUADACANAL STREET
Practice Address - Street 2:BRANCH MEDICAL CLININC (MCRD)
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140-5599
Practice Address - Country:US
Practice Address - Phone:619-524-4045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant