Provider Demographics
NPI:1477301844
Name:MORALES, DARYL LEE (BS PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:LEE
Last Name:MORALES
Suffix:
Gender:
Credentials:BS PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5980 WEBB ST
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-7625
Mailing Address - Country:US
Mailing Address - Phone:916-652-0171
Mailing Address - Fax:
Practice Address - Street 1:5980 WEBB ST
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-7625
Practice Address - Country:US
Practice Address - Phone:916-652-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator