MEDICARE: ANDREW MORELAND M.D., INC

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	207L00000X	Anesthesiology Physician	A20287	CA

General Provider Information

NPI Number	:	1174696074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW MORELAND M.D., INC

Provider Business Mailing Address
First Line	:	PO BOX 2757
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92859-0757
Country	:	US
Telephone Number	:	714-973-2650
Fax Number	:	714-973-2655

Provider Business Practice Location Address
First Line	:	1665 DOMINICAN WAY
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1528
Country	:	US
Telephone Number	:	831-476-6943
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW MORELAND
Credential	:	M.D.
Telephone Number	:	714-973-2650

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	10/04/2007

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