Provider Demographics
NPI:1023710043
Name:MORALES, LOUISE ALICE
Entity type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:ALICE
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 W HOLT BLVD STE 14
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3676
Mailing Address - Country:US
Mailing Address - Phone:909-675-6963
Mailing Address - Fax:
Practice Address - Street 1:954 W EL MORADO CT
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-2606
Practice Address - Country:US
Practice Address - Phone:909-589-9315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker