Healthcare Provider Details

I. General information

NPI: 1679963797
Provider Name (Legal Business Name): RAYMOND MORALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N PERRIS BLVD
PERRIS CA
92571-2811
US

IV. Provider business mailing address

555 N PERRIS BLVD
PERRIS CA
92571-2811
US

V. Phone/Fax

Practice location:
  • Phone: 951-436-5366
  • Fax: 951-436-5352
Mailing address:
  • Phone: 951-436-5366
  • Fax: 951-436-5352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: