Healthcare Provider Details

I. General information

NPI: 1154238533
Provider Name (Legal Business Name): JACQUELINE LUCIA MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 CHESS DR
FOSTER CITY CA
94404-1107
US

IV. Provider business mailing address

PO BOX 853
DINUBA CA
93618-0853
US

V. Phone/Fax

Practice location:
  • Phone: 659-312-7700
  • Fax:
Mailing address:
  • Phone: 559-859-1713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240178706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: