Basic Information
| Provider Information | |||||||||
| NPI: | 1952552481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORALES MENA | ||||||||
| FirstName: | ANABELLE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MORALES MENA | ||||||||
| OtherFirstName: | ANABELLE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1403 PARKVIEW DR | ||||||||
| Address2: | |||||||||
| City: | LYNDHURST | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441242403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035358599 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6559 WILSON MILLS RD | ||||||||
| Address2: | STE 106 | ||||||||
| City: | MAYFIELD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441433433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404491540 | ||||||||
| FaxNumber: | 4404602833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2008 | ||||||||
| LastUpdateDate: | 02/25/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-123509 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RR0500X | 35-123509 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.