Basic Information
| Provider Information | |||||||||
| NPI: | 1003008442 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORALES REDMON | ||||||||
| FirstName: | CYPRESS | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MFCC | ||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 5905 SOQUEL DR. SUITE #550 | ||||||||
| Address2: | |||||||||
| City: | SOQUEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314754508 | ||||||||
| FaxNumber: | 8313354374 | ||||||||
| Practice Location | |||||||||
| Address1: | 5905 SOQUEL DR STE 550 | ||||||||
| Address2: | |||||||||
| City: | SOQUEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950732861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314754508 | ||||||||
| FaxNumber: | 8313354374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2007 | ||||||||
| LastUpdateDate: | 08/21/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | MFC31371 | CA | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.