Provider Demographics
NPI:1871057455
Name:MORALES, MANUEL (BCBA)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 CROSSPOINTE CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0585
Mailing Address - Country:US
Mailing Address - Phone:805-587-1199
Mailing Address - Fax:
Practice Address - Street 1:5435 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1508
Practice Address - Country:US
Practice Address - Phone:310-933-4499
Practice Address - Fax:310-933-4134
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-33736103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst