Provider Demographics
NPI:1023205390
Name:MORALES, CARLOS GALVAN
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:GALVAN
Last Name:MORALES
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 1:980 W 6TH ST STE 124
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-1208
Mailing Address - Country:US
Mailing Address - Phone:909-648-8075
Mailing Address - Fax:
Practice Address - Street 1:980 W 6TH ST STE 124
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1208
Practice Address - Country:US
Practice Address - Phone:909-648-8075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW291981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical