Organization Name: | JORGE L MORAN MD INC |
NPI Number: | 1487795753 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JORGE L MORAN (PRESIDENT) |
Mailing Address: | 210 S Locust St Inglewood |
State: | CA US |
Postal Code: | 903012304 |
Phone Number: | 3106739920 |
Fax Number: | 3106739919 |
NPI Enumeration Date: | 02/09/2007 |
NPI Last Update Date: | 06/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A63662 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |