Individual
BENJAMIN MORALES MANACOP III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1007 E COOLEY DR STE 103, COLTON, CA 92324-3901
(951) 727-6460
(909) 219-5336
Mailing address
1007 E COOLEY DR STE 103, COLTON, CA 92324-3901
(951) 727-6460
(909) 219-5336
Taxonomy
Speciality
Code
Description
License number
State
163WX0200X
Oncology Registered Nurse
631790
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95030284
CA
Other
Enumeration date
01/11/2024
Last updated
01/12/2026
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