Provider Demographics
NPI:1982594628
Name:MORALES CARLO, OSVALDO ANIBAL
Entity type:Individual
Prefix:
First Name:OSVALDO
Middle Name:ANIBAL
Last Name:MORALES CARLO
Suffix:
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 1:449 IRONSIDE TRAIL DR # A
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-8259
Mailing Address - Country:US
Mailing Address - Phone:787-208-2886
Mailing Address - Fax:
Practice Address - Street 1:449 IRONSIDE TRAIL DR # A
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-8259
Practice Address - Country:US
Practice Address - Phone:787-208-2886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-05
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty