Provider Demographics
NPI:1396519732
Name:MORALES-LINNELL, CALLIA YESENIA (CMT)
Entity type:Individual
Prefix:
First Name:CALLIA
Middle Name:YESENIA
Last Name:MORALES-LINNELL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13761 REDSTONE ST
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-9188
Mailing Address - Country:US
Mailing Address - Phone:209-679-1942
Mailing Address - Fax:
Practice Address - Street 1:2307 OAKDALE RD STE 704
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2656
Practice Address - Country:US
Practice Address - Phone:209-800-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92953225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist