Provider Demographics
NPI:1811357106
Name:COSME-MORALES, JAVIER
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:COSME-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:HC 72 BOX 3596
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9778
Mailing Address - Country:US
Mailing Address - Phone:787-869-1290
Mailing Address - Fax:787-869-1800
Practice Address - Street 1:HC 72 BOX 3596
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-9778
Practice Address - Country:US
Practice Address - Phone:787-869-1290
Practice Address - Fax:787-869-1800
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11017104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0010112Medicaid