Provider Demographics
NPI:1548425291
Name:MORAN, JESSICA MARISOL (BA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARISOL
Last Name:MORAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5645 ALDAMA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2538
Mailing Address - Country:US
Mailing Address - Phone:323-257-9600
Mailing Address - Fax:323-999-2451
Practice Address - Street 1:45111 N. FERN AVE.
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-949-1206
Practice Address - Fax:661-940-5452
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2013-07-31
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner