Provider Demographics
NPI:1396597605
Name:MORALES FUENTES, LUIS YAMIL (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:YAMIL
Last Name:MORALES FUENTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772-0390
Mailing Address - Country:US
Mailing Address - Phone:939-759-5160
Mailing Address - Fax:
Practice Address - Street 1:CALLE CORCHADO 58
Practice Address - Street 2:CANOVANAS
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-256-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23673208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice