Provider Demographics
NPI:1619325875
Name:MORALES, JOHNNY (PA)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52142
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92517-3142
Mailing Address - Country:US
Mailing Address - Phone:951-454-4186
Mailing Address - Fax:
Practice Address - Street 1:1688 N PERRIS BLVD STE H4
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-4746
Practice Address - Country:US
Practice Address - Phone:951-657-7876
Practice Address - Fax:951-657-5799
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-28
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical