Provider Demographics
NPI:1154972792
Name:MORALES, LYDIA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
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 LA VEGA
Mailing Address - Street 2:CALLE C # 58
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766
Mailing Address - Country:US
Mailing Address - Phone:787-601-2225
Mailing Address - Fax:
Practice Address - Street 1:COMUNIDAD TOA VACA
Practice Address - Street 2:CALLE 13 # 561
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-601-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider