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General NPI Number Information
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NPI Number | 1508480120
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Entity Type | Individual
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Provider Name | NICOLE MORALDE
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Gender | Female
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 3100 SUMMIT ST STE 2549
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City | OAKLAND
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State | CA
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Zip | 94609-3412
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Country | US
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Telephone | 510-869-6656
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 BENJAMIN DR
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City | RICHMOND
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State | CA
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Zip | 94806-2773
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Country | US
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Telephone | 510-589-0536
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95013826
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95158487
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License Number State | CA
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