Provider Demographics
NPI:1679740591
Name:MORALES, ISMARIE (LND)
Entity Type:Individual
Prefix:MS
First Name:ISMARIE
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE. CIUDAD JARDIN
Mailing Address - Street 2:200 CALLE LIRIOS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-2213
Mailing Address - Country:US
Mailing Address - Phone:787-217-7589
Mailing Address - Fax:
Practice Address - Street 1:AVE. CIUDAD JARDIN CALLE LIRIO 200
Practice Address - Street 2:LIRIO
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-2213
Practice Address - Country:US
Practice Address - Phone:787-217-7589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1456133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered