Healthcare Provider Details

I. General information

NPI: 1780405159
Provider Name (Legal Business Name): ALLYNA NICOLE MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W 190TH ST STE 1000
GARDENA CA
90248-4255
US

IV. Provider business mailing address

17504 GRAND AVE APT 14
BELLFLOWER CA
90706-6800
US

V. Phone/Fax

Practice location:
  • Phone: 310-329-9115
  • Fax:
Mailing address:
  • Phone: 562-541-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: