Provider Demographics
NPI:1063719235
Name:MORAN CANALES, NIDIA M
Entity type:Individual
Prefix:MS
First Name:NIDIA
Middle Name:M
Last Name:MORAN CANALES
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 1:555 E OCEAN BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5052
Mailing Address - Country:US
Mailing Address - Phone:562-542-1144
Mailing Address - Fax:951-346-5511
Practice Address - Street 1:555 E OCEAN BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-5052
Practice Address - Country:US
Practice Address - Phone:562-542-1144
Practice Address - Fax:951-346-5511
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT51634106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty