Provider Demographics
NPI:1912216995
Name:MORALES, SAMUEL FELICIANO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:FELICIANO
Last Name:MORALES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 O ST STE 302
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1828
Mailing Address - Country:US
Mailing Address - Phone:559-369-4625
Mailing Address - Fax:559-369-7259
Practice Address - Street 1:2505 MERCED ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1811
Practice Address - Country:US
Practice Address - Phone:559-445-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant