Basic Information
| Provider Information | |||||||||
| NPI: | 1396346961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORALES | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | YAMILET | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27100 LANGSIDE AVE. | ||||||||
| Address2: | |||||||||
| City: | CANYON COUNTRY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238215782 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 18300 ROSCOE BLVD DIGNITY HEALTH- NORTHRIDGE HOSPITAL M | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188858500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2020 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 774111 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.