=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003008442
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYPRESS J. MORALES REDMON MFCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2007
-----------------------------------------------------
Last Update Date | 08/21/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5905 SOQUEL DR STE 550
-----------------------------------------------------
City | SOQUEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95073-2861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-475-4508
-----------------------------------------------------
Fax | 831-335-4374
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5905 SOQUEL DR. SUITE #550
-----------------------------------------------------
City | SOQUEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-475-4508
-----------------------------------------------------
Fax | 831-335-4374
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number | MFC31371
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------