Healthcare Provider Details

I. General information

NPI: 1487842027
Provider Name (Legal Business Name): MELVIN MORALES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W ADAMS BLVD
LOS ANGELES CA
90018-2039
US

IV. Provider business mailing address

14221 LAS VECINAS DR
LA PUENTE CA
91746-2608
US

V. Phone/Fax

Practice location:
  • Phone: 323-432-5185
  • Fax:
Mailing address:
  • Phone: 626-422-9236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: