Provider Demographics
NPI:1073519161
Name:MORALES, CHARLES (NP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 N MILLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3340
Mailing Address - Country:US
Mailing Address - Phone:559-431-6197
Mailing Address - Fax:559-431-8827
Practice Address - Street 1:7230 N MILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3340
Practice Address - Country:US
Practice Address - Phone:559-431-6197
Practice Address - Fax:559-431-8827
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS85710Medicare UPIN