Doctor Name: | MR. MATTHEW GABRIEL MORAN |
NPI Number: | 1043525587 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | N.P. |
License Number: | 19574 |
Business Practice Address: | 1695 N Sunrise Way Palm Springs, CA - 922623701 |
Business Phone Number: | 7603232118 |
Business Fax Number: | |
Mailing Address: | 1109 N Sunrise Way, PALM SPRINGS |
State: | CA |
Postal Code: | 922625310 |
Phone Number: | 7603232118 |
Fax Number: | |
NPI Enumeration Date: | 08/09/2010 |
NPI Last Update Date: | 01/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 19574 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |