Healthcare Provider Details

I. General information

NPI: 1043012776
Provider Name (Legal Business Name): DENNIS MOROZOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 DICKINSON STREET MPF BUILDING, MAIL CODE 0801
HILLCREST CA
92103
US

IV. Provider business mailing address

356 PROSPECT ST UNIT S2
LA JOLLA CA
92037
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-5297
  • Fax:
Mailing address:
  • Phone: 619-543-5297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: