Healthcare Provider Details

I. General information

NPI: 1003555343
Provider Name (Legal Business Name): DENISE REA-MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 CEDAR ST
RED BLUFF CA
96080-2709
US

IV. Provider business mailing address

852 PALM DR
COLTON CA
92324-2557
US

V. Phone/Fax

Practice location:
  • Phone: 530-355-8496
  • Fax:
Mailing address:
  • Phone: 805-714-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW106108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: