Basic Information
| Provider Information | |||||||||
| NPI: | 1649757808 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORALES | ||||||||
| FirstName: | RAY | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 UNIVERSITY AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958256509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164452050 | ||||||||
| FaxNumber: | 9164486050 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 UNIVERSITY AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958256509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164452050 | ||||||||
| FaxNumber: | 9164486050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2018 | ||||||||
| LastUpdateDate: | 07/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-18-31372 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.