Provider Demographics
NPI:1861793481
Name:MORALES, MARYANNE (DPT)
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 LAUREL CANYON BLVD STE 560
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1569
Mailing Address - Country:US
Mailing Address - Phone:818-763-0136
Mailing Address - Fax:
Practice Address - Street 1:6400 LAUREL CANYON BLVD STE 560
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1569
Practice Address - Country:US
Practice Address - Phone:818-763-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36853174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist