Provider Demographics
NPI:1063479475
Name:ENEIDA MORALES
Entity type:Organization
Organization Name:ENEIDA MORALES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROPIETARY
Authorized Official - Prefix:MISS
Authorized Official - First Name:ENEIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:787-877-1547
Mailing Address - Street 1:#1 CALLE A HERNANDEZ
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-877-1547
Mailing Address - Fax:787-877-1547
Practice Address - Street 1:1 CALLE A HERNANDEZ
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-1547
Practice Address - Fax:787-877-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR01279332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1322080001Medicare ID - Type UnspecifiedPROVIDER NUMBER