Healthcare Provider Details

I. General information

NPI: 1366786964
Provider Name (Legal Business Name): CESAR PORCAYO MORALES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 S MARYLAND PKWY
LAS VEGAS NV
89154-9900
US

IV. Provider business mailing address

7457 WAGONWHEEL RANCH WAY
LAS VEGAS NV
89113-3086
US

V. Phone/Fax

Practice location:
  • Phone: 702-895-0507
  • Fax:
Mailing address:
  • Phone: 714-317-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW79079
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW96233
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9786-C
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLCSW9786-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: