Provider Demographics
NPI:1760031736
Name:MORALES, STACEY RENEA (LM CPM)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:RENEA
Last Name:MORALES
Suffix:
Gender:F
Credentials:LM CPM
Other - Prefix:
Other - First Name:RENEA
Other - Middle Name:
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM CPM
Mailing Address - Street 1:5855 SILVEIRA ST
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-4627
Mailing Address - Country:US
Mailing Address - Phone:951-268-9008
Mailing Address - Fax:951-286-0026
Practice Address - Street 1:5855 SILVEIRA ST
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-4627
Practice Address - Country:US
Practice Address - Phone:951-268-9008
Practice Address - Fax:951-292-9255
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X, 261QB0400X, 374J00000X
CALM620176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoula