Provider Demographics
NPI:1386385482
Name:MORALES, MIRIAM MEDINA (RN)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:MEDINA
Last Name:MORALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 CAMPUS DR.
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230
Mailing Address - Country:US
Mailing Address - Phone:559-380-6602
Mailing Address - Fax:559-584-5672
Practice Address - Street 1:330 CAMPUS DR.
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:559-380-6602
Practice Address - Fax:559-584-5672
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95225773163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse