Healthcare Provider Details

I. General information

NPI: 1558295311
Provider Name (Legal Business Name): JUANITA E MORALES CADCII A053690324
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 OLIVE DR
BAKERSFIELD CA
93308-4144
US

IV. Provider business mailing address

901 OLIVE DR
BAKERSFIELD CA
93308-4144
US

V. Phone/Fax

Practice location:
  • Phone: 661-215-7652
  • Fax:
Mailing address:
  • Phone: 661-215-7652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA053690324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: