Provider Demographics
NPI:1114103538
Name:LUIS M MORALES SEDA
Entity type:Organization
Organization Name:LUIS M MORALES SEDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:ENID
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-878-0948
Mailing Address - Street 1:P.O. BOX 1389
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-878-0948
Mailing Address - Fax:
Practice Address - Street 1:CARR 681 KM 4.4 BO ISLOTE
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-0948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR941291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31307Medicare PIN