Provider Demographics
NPI:1912005034
Name:MORALES, TERESITA DE JESUS (PHD)
Entity Type:Individual
Prefix:
First Name:TERESITA
Middle Name:DE JESUS
Last Name:MORALES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 W 130TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5146
Mailing Address - Country:US
Mailing Address - Phone:626-449-2484
Mailing Address - Fax:
Practice Address - Street 1:625 FAIR OAKS AVENUE
Practice Address - Street 2:SUITE 390
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030
Practice Address - Country:US
Practice Address - Phone:626-449-2484
Practice Address - Fax:626-449-1107
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16668103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP16668BMedicare ID - Type UnspecifiedPSYCHOLOGIST
CAQ17640Medicare UPIN
CAWCP16668AMedicare ID - Type UnspecifiedPSYCHOLOGIST