MEDICARE: JESUS ALBERTO MORALES M.D.

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	207Q00000X	Family Medicine Physician	A95125	CA

General Provider Information

NPI Number	:	1134309578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS ALBERTO MORALES M.D.

Provider Business Mailing Address
First Line	:	32891 CALLE SAN MARCOS
Second Line	:
City	:	SAN JUAN CAPO
State	:	CA
Zip	:	92675-4434
Country	:	US
Telephone Number	:	310-916-8413
Fax Number	:

Provider Business Practice Location Address
First Line	:	32891 CALLE SAN MARCOS
Second Line	:
City	:	SAN JUAN CAPO
State	:	CA
Zip	:	92675-4434
Country	:	US
Telephone Number	:	310-916-8413
Fax Number	:

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

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	11/01/2021

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