Provider Demographics
NPI:1790518546
Name:MORALES, MABEL LYNETTE (PA)
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:LYNETTE
Last Name:MORALES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 URB MONTEMAR
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-3020
Mailing Address - Country:US
Mailing Address - Phone:787-380-7962
Mailing Address - Fax:
Practice Address - Street 1:5 URB MONTEMAR
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3020
Practice Address - Country:US
Practice Address - Phone:787-215-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2152363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant