Healthcare Provider Details

I. General information

NPI: 1851457527
Provider Name (Legal Business Name): MICHAEL D. MORELOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E 2ND AVE SUITE 202
ESCONDIDO CA
92025-4212
US

IV. Provider business mailing address

332 S JUNIPER ST STE 100
ESCONDIDO CA
92025-4941
US

V. Phone/Fax

Practice location:
  • Phone: 760-291-6799
  • Fax: 760-291-6949
Mailing address:
  • Phone: 760-291-6621
  • Fax: 760-737-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC41686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: