Provider Demographics
NPI:1386099752
Name:MOROGAN CASTRO, SIMONA DANA (MA)
Entity type:Individual
Prefix:MRS
First Name:SIMONA
Middle Name:DANA
Last Name:MOROGAN CASTRO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:SIMONA
Other - Middle Name:DANA
Other - Last Name:MOROGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:K5 CALLE 1
Mailing Address - Street 2:URB. LA MILAGROSA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-235-6947
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE K5
Practice Address - Street 2:URB. LA MILAGROSA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-235-6947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
CACU6527-03-1513174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No174400000XOther Service ProvidersSpecialist