Provider Demographics
NPI:1477670792
Name:MORALES LORA, JOSE MANUEL
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MANUEL
Last Name:MORALES LORA
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:LC35 VIA MAYORCA
Mailing Address - Street 2:L'ANTIGUA ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6102
Mailing Address - Country:US
Mailing Address - Phone:787-748-4089
Mailing Address - Fax:
Practice Address - Street 1:LC35 VIA MAYORCA
Practice Address - Street 2:L'ANTIGUA ENCANTADA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6102
Practice Address - Country:US
Practice Address - Phone:787-748-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14202208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice