Healthcare Provider Details

I. General information

NPI: 1285551879
Provider Name (Legal Business Name): NATALIE ANDREA MORELOS SUDRC 1 #22815
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4576 E SHIELDS AVE
FRESNO CA
93726-7220
US

IV. Provider business mailing address

4576 E SHIELDS AVE
FRESNO CA
93726-7220
US

V. Phone/Fax

Practice location:
  • Phone: 559-240-9206
  • Fax:
Mailing address:
  • Phone: 559-240-9206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: