Provider Demographics
NPI:1417282476
Name:MORALES, LINDA (C M)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:C M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82820 TRONA RD
Mailing Address - Street 2:
Mailing Address - City:TRONA
Mailing Address - State:CA
Mailing Address - Zip Code:93562-1929
Mailing Address - Country:US
Mailing Address - Phone:760-372-4524
Mailing Address - Fax:760-372-4526
Practice Address - Street 1:82820 TRONA RD
Practice Address - Street 2:
Practice Address - City:TRONA
Practice Address - State:CA
Practice Address - Zip Code:93562-1929
Practice Address - Country:US
Practice Address - Phone:760-372-4524
Practice Address - Fax:760-372-4526
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA251B00000XMedicare UPIN