Provider Demographics
NPI:1891019865
Name:MORALES, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:13260 IMMOKALEE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-1788
Mailing Address - Country:US
Mailing Address - Phone:239-692-8591
Mailing Address - Fax:239-692-8594
Practice Address - Street 1:13260 IMMOKALEE RD STE 2
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-1788
Practice Address - Country:US
Practice Address - Phone:239-692-8591
Practice Address - Fax:239-692-8594
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49050111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation