Healthcare Provider Details

I. General information

NPI: 1730018748
Provider Name (Legal Business Name): WALESKA MORALES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S NORFOLK ST STE 210
SAN MATEO CA
94403-1182
US

IV. Provider business mailing address

1900 S NORFOLK ST STE 210
SAN MATEO CA
94403-1182
US

V. Phone/Fax

Practice location:
  • Phone: 650-242-0179
  • Fax:
Mailing address:
  • Phone: 650-242-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number415-377-4703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: