Provider Demographics
NPI:1417198698
Name:MORALES, ESPERANZA G
Entity Type:Individual
Prefix:
First Name:ESPERANZA
Middle Name:G
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 CERRADO SANCHEZ
Mailing Address - Street 2:
Mailing Address - City:RIO RICO
Mailing Address - State:AZ
Mailing Address - Zip Code:85648-2825
Mailing Address - Country:US
Mailing Address - Phone:520-358-7061
Mailing Address - Fax:520-407-5398
Practice Address - Street 1:922 CERRADO SANCHEZ
Practice Address - Street 2:
Practice Address - City:RIO RICO
Practice Address - State:AZ
Practice Address - Zip Code:85648-2825
Practice Address - Country:US
Practice Address - Phone:520-721-1887
Practice Address - Fax:520-407-5398
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ432869171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ432869OtherSTATE OF ARIZONA OFFICE OF LICENSING, CERTIFICATION AND REGULATION