Provider Demographics
NPI:1851025191
Name:MORAES, MAEGAN
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:
Last Name:MORAES
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 1:5312 DIXON AVE W
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-9725
Mailing Address - Country:US
Mailing Address - Phone:707-301-8592
Mailing Address - Fax:
Practice Address - Street 1:5312 DIXON AVE W
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-9725
Practice Address - Country:US
Practice Address - Phone:707-301-8592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer