Healthcare Provider Details

I. General information

NPI: 1801281159
Provider Name (Legal Business Name): MICHELLE MORICCA RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 NIGHTSHADE
IRVINE CA
92603-0640
US

IV. Provider business mailing address

63 NIGHTSHADE
IRVINE CA
92603-0640
US

V. Phone/Fax

Practice location:
  • Phone: 949-300-6973
  • Fax:
Mailing address:
  • Phone: 949-300-6973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number383922
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number383922
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number383922
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number383922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: