Provider Demographics
NPI:1649978693
Name:RESPIRA MEDICAL AND WELLNESS CENTER
Entity type:Organization
Organization Name:RESPIRA MEDICAL AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIVET
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MORALES MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-967-3427
Mailing Address - Street 1:URB. ESTANCIA DE JUNCOS 112
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777
Mailing Address - Country:US
Mailing Address - Phone:939-276-1574
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL MENONITA DE HUMACAO
Practice Address - Street 2:300 SECTOR CUESTA LOS JOBOS
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:939-276-1574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039388100Medicaid