Basic Information
| Provider Information | |||||||||
| NPI: | 1881167088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORALES | ||||||||
| FirstName: | DIEGO | ||||||||
| MiddleName: | FRANCISCO | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | LP60904888 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 E. RAYMOND ST | ||||||||
| Address2: | |||||||||
| City: | BREWSTER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098814139 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1230 MONITOR ST | ||||||||
| Address2: | |||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988013534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093001221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2019 | ||||||||
| LastUpdateDate: | 01/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LP60904888 | WA | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | LP60904888 | 05 | WA | MEDICAID |