MEDICARE: MRS. HASMIK LIDA MOORADIAN P.T., M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator	11166	CA

General Provider Information

NPI Number	:	1144506940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HASMIK LIDA MOORADIAN P.T., M.A.

Provider Business Mailing Address
First Line	:	1950 PORT EDWARD PL
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-6614
Country	:	US
Telephone Number	:	949-350-6045
Fax Number	:	949-720-8359

Provider Business Practice Location Address
First Line	:	1950 PORT EDWARD PL
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-6614
Country	:	US
Telephone Number	:	949-350-6045
Fax Number	:	949-720-8359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	10/25/2011

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