Provider Demographics
NPI:1669459376
Name:MORALES, JULIETTE (MT)
Entity Type:Individual
Prefix:MRS
First Name:JULIETTE
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EDIFICIO MEDICO PROFESIONAL BORINQUEN
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-255-0208
Mailing Address - Fax:787-255-0330
Practice Address - Street 1:EDIFICIO MEDICO PROFESIONAL BORINQUEN
Practice Address - Street 2:SUITE 10
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-255-0208
Practice Address - Fax:787-255-0330
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6249246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31248Medicare ID - Type UnspecifiedPROVIDER NUMBER