Provider Demographics
NPI:1922136316
Name:MORALES, MINA
Entity Type:Individual
Prefix:MS
First Name:MINA
Middle Name:
Last Name:MORALES
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 1:3516 DOE SPRING RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3602
Mailing Address - Country:US
Mailing Address - Phone:951-737-3041
Mailing Address - Fax:951-274-9865
Practice Address - Street 1:1777 ATLANTA AVE STE G1
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-7417
Practice Address - Country:US
Practice Address - Phone:951-778-3500
Practice Address - Fax:951-274-9865
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)