Provider Demographics
NPI:1407605579
Name:MORALES MARCIAL, JUAN GABRIEL (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:GABRIEL
Last Name:MORALES MARCIAL
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 1:137 CALLE MAYAGUEZ APT 417
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5129
Mailing Address - Country:US
Mailing Address - Phone:787-235-6035
Mailing Address - Fax:
Practice Address - Street 1:RD 129, KM 1.0 AV. SAN LUIS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-235-6035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16626390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program