Provider Demographics
NPI:1730433707
Name:MORALES, MARITESS CASTILLO (MSN, RN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARITESS
Middle Name:CASTILLO
Last Name:MORALES
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3551
Mailing Address - Country:US
Mailing Address - Phone:707-428-4878
Mailing Address - Fax:
Practice Address - Street 1:1620 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE C
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3551
Practice Address - Country:US
Practice Address - Phone:707-428-4878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA748784163W00000X
CA22438363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF1212223OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS