Provider Demographics
NPI:1811421282
Name:MORALES, EILEEN (RD, LND,CDE)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:RD, LND,CDE
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 833
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0833
Mailing Address - Country:US
Mailing Address - Phone:787-675-8365
Mailing Address - Fax:
Practice Address - Street 1:F13 CALLE 3
Practice Address - Street 2:URB OCEAN VIEW
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-675-8365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1619133N00000X
PR1004952133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist