Healthcare Provider Details

I. General information

NPI: 1184652778
Provider Name (Legal Business Name): BRANDI H MORINOUE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HUGHES SUITE 100
IRVINE CA
92618-2059
US

IV. Provider business mailing address

6 HUGHES SUITE 100
IRVINE CA
92618-2059
US

V. Phone/Fax

Practice location:
  • Phone: 949-680-1880
  • Fax: 949-680-1919
Mailing address:
  • Phone: 949-680-1880
  • Fax: 949-680-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: