Provider Demographics
NPI:1700480894
Name:MORALES, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18370 MEDITERRANEAN BLVD APT 2508
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5744
Mailing Address - Country:US
Mailing Address - Phone:786-317-0672
Mailing Address - Fax:
Practice Address - Street 1:18370 MEDITERRANEAN BLVD APT 2508
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5744
Practice Address - Country:US
Practice Address - Phone:786-317-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9459736163W00000X
FL20-132307106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse