Provider Demographics
NPI:1164939633
Name:MORALES-BERAZA, SANDRA IRENE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:IRENE
Last Name:MORALES-BERAZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:MORALES-BERAZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:892 27TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1444
Mailing Address - Country:US
Mailing Address - Phone:619-575-4687
Mailing Address - Fax:619-575-1215
Practice Address - Street 1:829 27TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2710
Practice Address - Country:US
Practice Address - Phone:619-575-4687
Practice Address - Fax:619-575-1215
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health