Provider Demographics
NPI:1508648684
Name:SCRIMSHER MORALES, APOLONIO M
Entity Type:Individual
Prefix:
First Name:APOLONIO
Middle Name:M
Last Name:SCRIMSHER MORALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 S 42ND PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-9042
Mailing Address - Country:US
Mailing Address - Phone:831-206-2622
Mailing Address - Fax:
Practice Address - Street 1:5821 S 42ND PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-9042
Practice Address - Country:US
Practice Address - Phone:831-206-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach