Healthcare Provider Details

I. General information

NPI: 1932901097
Provider Name (Legal Business Name): JOSELYN N/A MORALES N/A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10252 SAN GABRIEL AVE
SOUTH GATE CA
90280-6681
US

IV. Provider business mailing address

10252 SAN GABRIEL AVE
SOUTH GATE CA
90280-6681
US

V. Phone/Fax

Practice location:
  • Phone: 323-840-5144
  • Fax:
Mailing address:
  • Phone: 323-840-5144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberF3066241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: