Provider Demographics
NPI:1912741984
Name:MORALES, MAIKA MARIE IMPERIAL (FNP)
Entity type:Individual
Prefix:
First Name:MAIKA MARIE
Middle Name:IMPERIAL
Last Name:MORALES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 W FOOTHILL BLVD # 456
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3363
Mailing Address - Country:US
Mailing Address - Phone:323-203-8050
Mailing Address - Fax:
Practice Address - Street 1:420 W ROWLAND ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2943
Practice Address - Country:US
Practice Address - Phone:626-331-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily