Healthcare Provider Details

I. General information

NPI: 1962043968
Provider Name (Legal Business Name): KASHMIER IRVAE MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILMINGTON AVE
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

12021 WILMINGTON AVE
LOS ANGELES CA
90059-3019
US

V. Phone/Fax

Practice location:
  • Phone: 424-454-6027
  • Fax:
Mailing address:
  • Phone: 424-454-6027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16511
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: