Provider Demographics
NPI:1326619453
Name:PORTAL MORALES, FRANK
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:PORTAL MORALES
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 1:13395 SW 250TH LN APT 104
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6096
Mailing Address - Country:US
Mailing Address - Phone:786-650-5372
Mailing Address - Fax:
Practice Address - Street 1:13395 SW 250TH LN APT 104
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6096
Practice Address - Country:US
Practice Address - Phone:786-650-5372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician