Provider Demographics
NPI:1922215367
Name:MORALES, SERGIO (PA)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 OLIVA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-3514
Mailing Address - Country:US
Mailing Address - Phone:562-756-0955
Mailing Address - Fax:
Practice Address - Street 1:16660 PARAMOUNT BLVD STE 206
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5458
Practice Address - Country:US
Practice Address - Phone:563-634-9433
Practice Address - Fax:562-634-6075
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17242363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant