Provider Demographics
NPI:1891411435
Name:MORALES, JOEMIN IVETTE
Entity Type:Individual
Prefix:MS
First Name:JOEMIN
Middle Name:IVETTE
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CALLE TULIPAN
Mailing Address - Street 2:COMUNIDAD LAS FLORES
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:787-679-1030
Mailing Address - Fax:
Practice Address - Street 1:8 CALLE TULIPAN
Practice Address - Street 2:COMUNIDAD LAS FLORES
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-679-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4329031172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver