Provider Demographics
NPI:1144429457
Name:MORALES, BERNADETTE
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GRAND AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3641
Mailing Address - Country:US
Mailing Address - Phone:650-244-1441
Mailing Address - Fax:650-244-1447
Practice Address - Street 1:301 GRAND AVE STE 301
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3641
Practice Address - Country:US
Practice Address - Phone:650-244-1441
Practice Address - Fax:650-244-1447
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA97037OtherOLLIN
CA41491OtherENTRE FAMILIA OP
99037OtherOLLIN - PROP. 36