Provider Demographics
NPI:1982201224
Name:MORALES CORA, RICARDO YAMIL
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:YAMIL
Last Name:MORALES CORA
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:URB VILLA ANDALUCIA
Mailing Address - Street 2:M-19 CALLE FRONTERA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-667-2289
Mailing Address - Fax:
Practice Address - Street 1:URB VILLA ANDALUCIA
Practice Address - Street 2:M-19 CALLE FRONTERA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-0092
Practice Address - Country:US
Practice Address - Phone:787-667-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR473310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC19666250OtherNURSING HOME OWNER