Healthcare Provider Details

I. General information

NPI: 1154105419
Provider Name (Legal Business Name): LANI NICOLE MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10990 SAN DIEGO MISSION RD
SAN DIEGO CA
92108-2417
US

IV. Provider business mailing address

5500 MORRO WAY APT 73
LA MESA CA
91942-2175
US

V. Phone/Fax

Practice location:
  • Phone: 619-641-4224
  • Fax:
Mailing address:
  • Phone: 619-623-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: