Provider Demographics
NPI:1740342823
Name:REYES MORALES, EMMA
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:REYES MORALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND. TERRAZAS DE PARQUE ESCORIAL
Mailing Address - Street 2:APTO. 4510
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-403-0136
Mailing Address - Fax:
Practice Address - Street 1:COND. TERRAZAS DE PARQUE ESCORIAL
Practice Address - Street 2:APTO. 4510
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-403-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2284103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical