Provider Demographics
NPI:1942863071
Name:MORALES, JONATHAN (BSN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:BSN
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 1277
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1277
Mailing Address - Country:US
Mailing Address - Phone:787-737-2311
Mailing Address - Fax:787-737-2377
Practice Address - Street 1:941 SAN ANTONIO FINAL ST RT SALIDA BARRIO JAGUAS
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-1277
Practice Address - Country:US
Practice Address - Phone:787-737-2311
Practice Address - Fax:787-737-2377
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR78656163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice