Provider Demographics
NPI:1912792839
Name:MORALES RIVERA, EDGARDO (PA)
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:
Last Name:MORALES RIVERA
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:EDGARDO
Other - Middle Name:
Other - Last Name:MORALES RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:500 BLVD DEL RIO APT 3902
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4507
Mailing Address - Country:US
Mailing Address - Phone:609-206-5672
Mailing Address - Fax:
Practice Address - Street 1:CALLE MAGA FINAL
Practice Address - Street 2:TERRENOS HOSPITAL PSIQUIATRIA
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00928
Practice Address - Country:US
Practice Address - Phone:787-228-2879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1628PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical