Provider Demographics
NPI:1760421226
Name:MORALES, NOEL RODERICK
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:RODERICK
Last Name:MORALES
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:PO BOX 4035
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-4035
Mailing Address - Country:US
Mailing Address - Phone:787-854-6462
Mailing Address - Fax:787-854-6462
Practice Address - Street 1:15 CALLE TULIO OTERO
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4343
Practice Address - Country:US
Practice Address - Phone:787-855-5963
Practice Address - Fax:787-855-5963
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04132DM-7207VC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VC0200XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE09026Medicare UPIN
PR95267Medicare PIN