1528382397 NPI number — DEISY MON MORALES, DDS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528382397 NPI number — DEISY MON MORALES, DDS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEISY MON MORALES, DDS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UNITED DENTAL OFFICE OF DEISY MON MORALES, DDS, INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528382397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11912 VALLEY BLVD
Provider Second Line Business Mailing Address:
STE: A
Provider Business Mailing Address City Name:
EL MONTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91732-3153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-442-6500
Provider Business Mailing Address Fax Number:
626-442-6502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11912 VALLEY BLVD
Provider Second Line Business Practice Location Address:
STE: A
Provider Business Practice Location Address City Name:
EL MONTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91732-3153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-442-6500
Provider Business Practice Location Address Fax Number:
626-442-6502
Provider Enumeration Date:
03/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MORALES
Authorized Official First Name:
MARLON
Authorized Official Middle Name:
MOISES
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
626-442-6500

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  55819 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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