Healthcare Provider Details

I. General information

NPI: 1033551809
Provider Name (Legal Business Name): ALICIA MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 03/29/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90022-1209
US

IV. Provider business mailing address

4701 CESAR CHAVEZ AVE., 2ND FL
LOS ANGELES CA
90022
US

V. Phone/Fax

Practice location:
  • Phone: 323-267-3400
  • Fax:
Mailing address:
  • Phone: 323-267-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW63151
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW81501
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: