Healthcare Provider Details

I. General information

NPI: 1114805330
Provider Name (Legal Business Name): LINDA MORALES LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 12TH ST
MARINA CA
93933-6003
US

IV. Provider business mailing address

PO BOX 1230
GONZALES CA
93926-1230
US

V. Phone/Fax

Practice location:
  • Phone: 831-647-7652
  • Fax:
Mailing address:
  • Phone: 831-578-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number276748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: