Provider Demographics
NPI:1346881091
Name:MORALES, ALBERT
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:MORALES
Suffix:
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:PO BOX 46151
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87174-6151
Mailing Address - Country:US
Mailing Address - Phone:505-524-0710
Mailing Address - Fax:505-524-0715
Practice Address - Street 1:2345 SOUTHERN BLVD SE STE B11
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3744
Practice Address - Country:US
Practice Address - Phone:505-524-0710
Practice Address - Fax:505-524-0715
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM57885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily