Individual
JOHN ROBERT MORALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CP, BOCO
Contact information
Practice address
65 MONTGOMERY DR, SANTA ROSA, CA 95404-6616
(707) 544-5347
(707) 544-5349
Mailing address
65 MONTGOMERY DR, SANTA ROSA, CA 95404-6616
(707) 544-5347
(707) 544-5349
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68-0179199
OTHER
—
05
—
XB0013930
—
CA
Enumeration date
03/27/2007
Last updated
03/17/2009
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