Provider Demographics
NPI:1265656235
Name:MORALES, GLORIA (MD)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:MD
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 4952
Mailing Address - Street 2:PMB 474
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4952
Mailing Address - Country:US
Mailing Address - Phone:787-744-8645
Mailing Address - Fax:787-746-2898
Practice Address - Street 1:URB. MANSIONES DEL PARAISO #35
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-744-8645
Practice Address - Fax:787-746-2898
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10954208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDM104992OtherESTATAL
PRBM3479258OtherFEDERAL