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General NPI Number Information
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NPI Number | 1174293252
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Entity Type | Individual
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Provider Name | JOHN CARLO DICDICAN MORALES
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Gender | Male
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 12930 SARATOGA AVE STE B5
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City | SARATOGA
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State | CA
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Zip | 95070-4661
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Country | US
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Telephone | 408-763-4905
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Fax |
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Provider Business Mailing Address
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Address Line | 1669 BLACK HAWK LN APT 51
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City | MCKINLEYVILLE
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State | CA
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Zip | 95519-4280
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 300955
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License Number State | CA
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