Healthcare Provider Details

I. General information

NPI: 1245374339
Provider Name (Legal Business Name): STEPHEN PAUL MORITA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 IRVINE AVE SUITE 116
COSTA MESA CA
92627-4653
US

IV. Provider business mailing address

2675 IRVINE AVE SUITE 116
COSTA MESA CA
92627-4653
US

V. Phone/Fax

Practice location:
  • Phone: 949-631-0200
  • Fax: 949-631-2050
Mailing address:
  • Phone: 949-631-0200
  • Fax: 949-631-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number20320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: