Healthcare Provider Details

I. General information

NPI: 1639073281
Provider Name (Legal Business Name): OLIVIA JADE MORALES OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9009 CAMPO RD
SPRING VALLEY CA
91977-1112
US

IV. Provider business mailing address

3721 1/2 BANCROFT ST
SAN DIEGO CA
92104-3707
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-2711
  • Fax:
Mailing address:
  • Phone: 805-746-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number29035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: