Healthcare Provider Details

I. General information

NPI: 1114377199
Provider Name (Legal Business Name): JOSE ANDRES MORALES CORADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDRES MORALES CORADO MD

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 UCLA MEDICAL PLZ STE 3100
LOS ANGELES CA
90095-8346
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6581
  • Fax: 310-206-8616
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberA161140
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number315615
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License NumberA161140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: