Basic Information
| Provider Information | |||||||||
| NPI: | 1316138076 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORALES | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | KUUIPOLANI | ||||||||
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| Credential: | B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 658 E BRIER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924155840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095010723 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9540 CENTER AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917305840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099802789 | ||||||||
| FaxNumber: | 9099802689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2007 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.