Healthcare Provider Details

I. General information

NPI: 1215297866
Provider Name (Legal Business Name): DEANNDRA DONNETTE MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3561 WHITE HORSE DR SE
RIO RANCHO NM
87124-3674
US

IV. Provider business mailing address

3561 WHITE HORSE DR SE
RIO RANCHO NM
87124-3674
US

V. Phone/Fax

Practice location:
  • Phone: 619-942-1195
  • Fax:
Mailing address:
  • Phone: 619-942-1195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number989
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0291
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: