Provider Demographics
NPI:1740829944
Name:MORALES, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
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 1:1101 N GEORGETOWN ST APT 909
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3266
Mailing Address - Country:US
Mailing Address - Phone:512-850-9166
Mailing Address - Fax:
Practice Address - Street 1:1812 CENTRE CREEK DR STE 115
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5133
Practice Address - Country:US
Practice Address - Phone:512-579-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
TX153095183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No174H00000XOther Service ProvidersHealth Educator