Provider Demographics
NPI:1205693777
Name:MORALES ROSARIO, OMAR ISMAEL
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:ISMAEL
Last Name:MORALES ROSARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VISTAS DE RIO GRANDE II #476 CALLE REINA DE LAS FLORES
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-242-2861
Mailing Address - Fax:
Practice Address - Street 1:VISTAS DE RIO GRANDE II #476 CALLE REINA DE LAS FLORES
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-242-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program