Provider Demographics
NPI:1568950400
Name:MORALEZ, MELINDA MARIE
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MARIE
Last Name:MORALEZ
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 1:180 THRIFT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2921
Mailing Address - Country:US
Mailing Address - Phone:661-487-8132
Mailing Address - Fax:
Practice Address - Street 1:180 THRIFT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-2921
Practice Address - Country:US
Practice Address - Phone:661-487-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1302520418101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA9317259OtherDRIVERS LICENSE