Provider Demographics
NPI:1881167088
Name:MORALES, DIEGO FRANCISCO SR (LP60904888)
Entity type:Individual
Prefix:MR
First Name:DIEGO
Middle Name:FRANCISCO
Last Name:MORALES
Suffix:SR
Gender:M
Credentials:LP60904888
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 E. RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812
Mailing Address - Country:US
Mailing Address - Phone:509-881-4139
Mailing Address - Fax:
Practice Address - Street 1:1230 MONITOR ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3534
Practice Address - Country:US
Practice Address - Phone:509-300-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60904888164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALP60904888Medicaid