Provider Demographics
NPI:1679723084
Name:MORALES, LAURA MARIA (PA - C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIA
Last Name:MORALES
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3655 W ANTHEM WAY STE A109
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0430
Mailing Address - Country:US
Mailing Address - Phone:623-879-5288
Mailing Address - Fax:623-879-1563
Practice Address - Street 1:19829 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4001
Practice Address - Country:US
Practice Address - Phone:623-879-5288
Practice Address - Fax:623-879-1563
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4277363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical