Provider Demographics
NPI:1972538825
Name:MORALES- COLON, MARICELIS (MD)
Entity type:Individual
Prefix:
First Name:MARICELIS
Middle Name:
Last Name:MORALES- COLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 N JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3221
Mailing Address - Country:US
Mailing Address - Phone:866-218-1211
Mailing Address - Fax:407-809-5245
Practice Address - Street 1:1962 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3221
Practice Address - Country:US
Practice Address - Phone:866-218-1211
Practice Address - Fax:407-809-5245
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14430208D00000X
FLACN 434208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005570400Medicaid
PR22075Medicare PIN
FL005570400Medicaid