Provider Demographics
NPI:1932711991
Name:MORAES, ROBERTA (CMT)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:MORAES
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 1:955 LANE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4525
Mailing Address - Country:US
Mailing Address - Phone:619-500-4615
Mailing Address - Fax:619-414-1387
Practice Address - Street 1:955 LANE AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4525
Practice Address - Country:US
Practice Address - Phone:619-500-4615
Practice Address - Fax:619-414-1387
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65398225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA65398OtherCERTIFICATION/LICENSE NUMBER