MEDICARE: DANIEL 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1992404644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL MORALES

Provider Business Mailing Address
First Line	:	8700 PERSHING DR UNIT 1213
Second Line	:
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-8009
Country	:	US
Telephone Number	:	805-402-7835
Fax Number	:

Provider Business Practice Location Address
First Line	:	17982 SKY PARK CIR STE D
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-6408
Country	:	US
Telephone Number	:	949-809-5798
Fax Number	:

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

Provider Enumeration Date	:	03/01/2023
Last Update Date	:	03/01/2023

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