MEDICARE: KASHMIER IRVAE MORALES

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	16511	CA
2	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1962043968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASHMIER IRVAE MORALES

Provider Business Mailing Address
First Line	:	12021 WILMINGTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3019
Country	:	US
Telephone Number	:	424-454-6027
Fax Number	:

Provider Business Practice Location Address
First Line	:	12021 WILMINGTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3019
Country	:	US
Telephone Number	:	424-454-6027
Fax Number	:

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

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	03/11/2026

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Directions to “ KASHMIER IRVAE MORALES ” Practice Location

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