Provider Demographics
NPI:1467248609
Name:MORALES, ISAAC DANIEL
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:DANIEL
Last Name:MORALES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 NW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7020
Mailing Address - Country:US
Mailing Address - Phone:561-722-4377
Mailing Address - Fax:
Practice Address - Street 1:3945 NW 60TH AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-7020
Practice Address - Country:US
Practice Address - Phone:561-722-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM618349913000106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician