Provider Demographics
NPI:1871822866
Name:MORALES HECHAVARRIA, YORDAN (LSA)
Entity Type:Individual
Prefix:MR
First Name:YORDAN
Middle Name:
Last Name:MORALES HECHAVARRIA
Suffix:
Gender:M
Credentials:LSA
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 38450
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77238-8450
Mailing Address - Country:US
Mailing Address - Phone:832-461-9413
Mailing Address - Fax:281-890-8938
Practice Address - Street 1:11006 WARATH OAK CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5490
Practice Address - Country:US
Practice Address - Phone:832-461-9413
Practice Address - Fax:281-890-8938
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00348363AS0400X, 246ZS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0400XSpecialist/Technologist, OtherSurgical
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical