Provider Demographics
NPI:1619630787
Name:MORALES, FERNANDO GINO (RN)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:GINO
Last Name:MORALES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:F
Other - Middle Name:G
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1720 EAST CESAR CHAVEZ AVE.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1437
Mailing Address - Country:US
Mailing Address - Phone:323-265-5095
Mailing Address - Fax:
Practice Address - Street 1:1720 EAST CESAR CHAVEZ AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-268-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA561684163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult