Provider Demographics
NPI:1568020436
Name:MORALES LODIS, ELLEN SUSANA
Entity Type:Individual
Prefix:
First Name:ELLEN SUSANA
Middle Name:
Last Name:MORALES LODIS
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 1:20661 FORGE WAY UNIT 365
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-6379
Mailing Address - Country:US
Mailing Address - Phone:408-707-8216
Mailing Address - Fax:
Practice Address - Street 1:20661 FORGE WAY UNIT 365
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-6379
Practice Address - Country:US
Practice Address - Phone:408-707-8216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator