Healthcare Provider Details

I. General information

NPI: 1427835974
Provider Name (Legal Business Name): XIOMARA MAIBELIE MORALES MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 UNIVERSITY AVE STE E107
SAN DIEGO CA
92103-3359
US

IV. Provider business mailing address

1050 UNIVERSITY AVE STE E107
SAN DIEGO CA
92103-3359
US

V. Phone/Fax

Practice location:
  • Phone: 657-204-3567
  • Fax:
Mailing address:
  • Phone: 805-757-6152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number13197
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT163670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: