Provider Demographics
NPI:1821181611
Name:MORALES, RODOLFO ALEJANDRO (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:ALEJANDRO
Last Name:MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:ALEX
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2516 SAMARITAN DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4108
Mailing Address - Country:US
Mailing Address - Phone:408-358-7033
Mailing Address - Fax:408-358-7031
Practice Address - Street 1:2516 SAMARITAN DR
Practice Address - Street 2:SUITE G
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4108
Practice Address - Country:US
Practice Address - Phone:408-358-7033
Practice Address - Fax:408-358-7031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA759632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A759630Medicare ID - Type Unspecified
H49686Medicare UPIN