Healthcare Provider Details

I. General information

NPI: 1245362441
Provider Name (Legal Business Name): ELIZABETH MORALES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 JOHN JONES RD
DAVIS CA
95616-9701
US

IV. Provider business mailing address

PO BOX 1260
DAVIS CA
95617-1260
US

V. Phone/Fax

Practice location:
  • Phone: 530-758-2060
  • Fax:
Mailing address:
  • Phone: 530-285-3201
  • Fax: 530-758-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number201408563NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: