Provider Demographics
NPI:1740416320
Name:MORALES MITTI, CARLOS M (BA)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:M
Last Name:MORALES MITTI
Suffix:
Gender:M
Credentials:BA
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2757 CORAL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4039
Mailing Address - Country:US
Mailing Address - Phone:215-459-7301
Mailing Address - Fax:215-851-1775
Practice Address - Street 1:1207 CHESTNUT ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4101
Practice Address - Country:US
Practice Address - Phone:215-851-1822
Practice Address - Fax:215-851-1775
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101708256Medicaid