Provider Demographics
NPI:1962509828
Name:MORANTES, MARIA CONSUELO (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CONSUELO
Last Name:MORANTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:M
Other - Middle Name:CONNIE
Other - Last Name:MORANTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:MAILSTOP S-123-GMS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-764-2551
Mailing Address - Fax:206-768-5440
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:MAILSTOP S-123-GMS
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-764-2551
Practice Address - Fax:206-768-5440
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00029988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine