MEDICARE: MRS. LOUISE ALICE MORALES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1023710043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOUISE ALICE MORALES

Provider Business Mailing Address
First Line	:	931 W HOLT BLVD STE 14
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-3676
Country	:	US
Telephone Number	:	909-675-6963
Fax Number	:

Provider Business Practice Location Address
First Line	:	954 W EL MORADO CT
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-2606
Country	:	US
Telephone Number	:	909-589-9315
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2023
Last Update Date	:	03/21/2023

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