Provider Demographics
NPI:1649496373
Name:MORALES, MARIEL (RT)
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CALLE POMAROSAS
Mailing Address - Street 2:URB. MONTE ELENA
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-5603
Mailing Address - Country:US
Mailing Address - Phone:787-697-2926
Mailing Address - Fax:
Practice Address - Street 1:120 CALLE POMAROSAS
Practice Address - Street 2:URB. MONTE ELENA
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-5603
Practice Address - Country:US
Practice Address - Phone:787-697-2926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002417247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist