Provider Demographics
NPI:1740025204
Name:MORALES, BRINA MARIE
Entity type:Individual
Prefix:
First Name:BRINA
Middle Name:MARIE
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:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:WINKELMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:85192-0025
Mailing Address - Country:US
Mailing Address - Phone:928-275-0334
Mailing Address - Fax:
Practice Address - Street 1:208 E PINE KNOLL DRIVE ROOM 215 BUILDING 66
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86011-0001
Practice Address - Country:US
Practice Address - Phone:928-523-7147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program