Healthcare Provider Details

I. General information

NPI: 1932450186
Provider Name (Legal Business Name): OLIVIA ANNE MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17195 NEWHOPE ST STE 210
FOUNTAIN VALLEY CA
92708-4211
US

IV. Provider business mailing address

8243 NORWALK BLVD
WHITTIER CA
90606-3164
US

V. Phone/Fax

Practice location:
  • Phone: 657-360-4329
  • Fax:
Mailing address:
  • Phone: 562-321-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF79714
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number138673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: