Healthcare Provider Details

I. General information

NPI: 1487570750
Provider Name (Legal Business Name): JUAN CARLOS MORALES TABLADA MT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 GRAND AVE
OAKLAND CA
94610-1505
US

IV. Provider business mailing address

1955 CHESTNUT ST APT 305
BERKELEY CA
94702-1745
US

V. Phone/Fax

Practice location:
  • Phone: 510-213-8192
  • Fax:
Mailing address:
  • Phone: 510-520-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number93817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: