Provider Demographics
NPI:1750520102
Name:MORALES ALICEA, CARLOS A SR
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:A
Last Name:MORALES ALICEA
Suffix:SR
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:PMB 073 PO BOX 8901
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-8901
Mailing Address - Country:US
Mailing Address - Phone:787-820-3198
Mailing Address - Fax:787-820-3198
Practice Address - Street 1:CARR 130 KM 10.3 INT
Practice Address - Street 2:BO CAMPO ALEGRE
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-0000
Practice Address - Country:US
Practice Address - Phone:787-820-3198
Practice Address - Fax:787-820-3198
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTP161171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRTP161OtherTP 161 BILLING NUMBER