Basic Information
Provider Information
NPI: 1891338653
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORALES
FirstName: LIGIA
MiddleName: DE LOS ANGELES
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 18301 SW 146TH AVE
Address2:  
City: MIAMI
State: FL
PostalCode: 331777682
CountryCode: US
TelephoneNumber: 3057640066
FaxNumber:  
Practice Location
Address1: 654 NE 9TH PL
Address2:  
City: HOMESTEAD
State: FL
PostalCode: 330304934
CountryCode: US
TelephoneNumber: 3052483488
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/24/2019
LastUpdateDate: 10/24/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X  Y Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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