MEDICARE: CORAZON OBLEA MORALES DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	37148	CA

General Provider Information

NPI Number	:	1730308131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORAZON OBLEA MORALES DMD

Provider Business Mailing Address
First Line	:	7316 MISSION ST
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94014-2666
Country	:	US
Telephone Number	:	650-755-0959
Fax Number	:	650-757-9549

Provider Business Practice Location Address
First Line	:	7316 MISSION ST
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94014-2666
Country	:	US
Telephone Number	:	650-755-0959
Fax Number	:	650-757-9549

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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