Provider Demographics
NPI:1366603920
Name:MORALES-BRONNER, SYLVIA (MD)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:MORALES-BRONNER
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 1:3516 12TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5218
Mailing Address - Country:US
Mailing Address - Phone:360-918-0604
Mailing Address - Fax:360-456-6504
Practice Address - Street 1:3516 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5218
Practice Address - Country:US
Practice Address - Phone:360-918-0604
Practice Address - Fax:360-456-6504
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00049261174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2000297Medicaid
WAMD00049261OtherWASHINGTON STATE DEPT. OF HEALTH