Basic Information
| Provider Information | |||||||||
| NPI: | 1770754897 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORAUSKE | ||||||||
| FirstName: | MARIANGELI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 W PUTNAM AVE | ||||||||
| Address2: | |||||||||
| City: | PORTERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932573472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596870929 | ||||||||
| FaxNumber: | 5596858953 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 N K ST | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932744005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596870929 | ||||||||
| FaxNumber: | 5596858953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2008 | ||||||||
| LastUpdateDate: | 02/24/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 59386-INTERN | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.