Provider Demographics
NPI:1376307587
Name:MORALES RODRIGUEZ, WILLIAM ALFONSO
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALFONSO
Last Name:MORALES RODRIGUEZ
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:HC 5 BOX 9416
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-9351
Mailing Address - Country:US
Mailing Address - Phone:787-909-7366
Mailing Address - Fax:787-256-5284
Practice Address - Street 1:CONDOMINIO PARK VIEW TERRACE
Practice Address - Street 2:EDIFICIO 10 APARTAMENTO 301
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-909-7366
Practice Address - Fax:787-256-5284
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4314820172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver