Provider Demographics
NPI:1255414728
Name:MORALES BLANCO, MARIA M (OD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:M
Last Name:MORALES BLANCO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 143201
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-3201
Mailing Address - Country:US
Mailing Address - Phone:787-366-0563
Mailing Address - Fax:
Practice Address - Street 1:AGUADILLA MALL # 39
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4953
Practice Address - Country:US
Practice Address - Phone:787-882-0078
Practice Address - Fax:877-899-0454
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU196228Medicare UPIN