Healthcare Provider Details

I. General information

NPI: 1992366314
Provider Name (Legal Business Name): RUTH TZIPORA MORIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUTH TZIPORA BORNSTEIN

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16405 SAND CANYON AVE STE 220
IRVINE CA
92618-3787
US

IV. Provider business mailing address

16405 SAND CANYON AVE STE 220
IRVINE CA
92618-3787
US

V. Phone/Fax

Practice location:
  • Phone: 949-336-8633
  • Fax:
Mailing address:
  • Phone: 949-336-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301017855
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: