Provider Demographics
NPI:1134309578
Name:MORALES, JESUS ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ALBERTO
Last Name:MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32891 CALLE SAN MARCOS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-4434
Mailing Address - Country:US
Mailing Address - Phone:310-916-8413
Mailing Address - Fax:
Practice Address - Street 1:32891 CALLE SAN MARCOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPO
Practice Address - State:CA
Practice Address - Zip Code:92675-4434
Practice Address - Country:US
Practice Address - Phone:310-916-8413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine