Provider Demographics
NPI:1841597929
Name:MORALES, DANERIS A (LND)
Entity Type:Individual
Prefix:
First Name:DANERIS
Middle Name:A
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0606
Mailing Address - Country:US
Mailing Address - Phone:787-640-3611
Mailing Address - Fax:
Practice Address - Street 1:PONCE BY PASS
Practice Address - Street 2:SUITE 509-2225
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1382
Practice Address - Country:US
Practice Address - Phone:787-284-7150
Practice Address - Fax:787-842-1199
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1604133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist