Provider Demographics
NPI:1962046524
Name:MORELOS, RANDY SARNILLO
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:SARNILLO
Last Name:MORELOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9152 CHIANTI CIRCLE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212
Mailing Address - Country:US
Mailing Address - Phone:209-475-0186
Mailing Address - Fax:888-236-3319
Practice Address - Street 1:9152 CHIANTI CIRCLE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212
Practice Address - Country:US
Practice Address - Phone:209-475-0186
Practice Address - Fax:888-236-3319
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility