Healthcare Provider Details

I. General information

NPI: 1437838190
Provider Name (Legal Business Name): BRIAN JAMES MORIOKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRIAN JAMES MORIOKA D.D.S

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 VIA DEL LOMAS
AROMAS CA
95004-9021
US

IV. Provider business mailing address

765 VIA DEL LOMAS
AROMAS CA
95004-9021
US

V. Phone/Fax

Practice location:
  • Phone: 408-499-8844
  • Fax:
Mailing address:
  • Phone: 408-499-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: