Provider Demographics
NPI:1942567334
Name:MORALES SANTIAGO, EVA M
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:M
Last Name:MORALES SANTIAGO
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:VILLAS DEL SOL CALLE TORRE MOLINO
Mailing Address - Street 2:#407
Mailing Address - City:CAROLINA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00985
Mailing Address - Country:UM
Mailing Address - Phone:787-769-6617
Mailing Address - Fax:
Practice Address - Street 1:CORPORACION DEL FONDO DEL SEGURO DEL ESTADO
Practice Address - Street 2:CARR #3, 65TH INFANTERIA, SECTOR COMUNIDSAD ESCORIAL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-757-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1494091OtherDRIVERS LICENCE