Provider Demographics
NPI:1588454391
Name:CARREON MORAN, ROSA DAISY (PPS)
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:DAISY
Last Name:CARREON MORAN
Suffix:
Gender:
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 W SUNNYSIDE CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7789
Mailing Address - Country:US
Mailing Address - Phone:559-827-1020
Mailing Address - Fax:
Practice Address - Street 1:1150 N HAYES AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-3157
Practice Address - Country:US
Practice Address - Phone:559-595-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200117605101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool