Provider Demographics
NPI:1609378660
Name:MORALES, FERNANDO RAFAEL III
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:RAFAEL
Last Name:MORALES
Suffix:III
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 1:630 S RANCHO DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4849
Mailing Address - Country:US
Mailing Address - Phone:702-998-9505
Mailing Address - Fax:702-527-7939
Practice Address - Street 1:630 S RANCHO DR STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4849
Practice Address - Country:US
Practice Address - Phone:702-998-9505
Practice Address - Fax:702-527-7939
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician