Healthcare Provider Details

I. General information

NPI: 1750718631
Provider Name (Legal Business Name): DANIELLE K MOUL MD INC APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26730 CROWN VALLEY PKWY SUITE 250
MISSION VIEJO CA
92691-6364
US

IV. Provider business mailing address

303 BROADWAY ST SUITE 104 PMB 135
LAGUNA BEACH CA
92651-1816
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-2440
  • Fax: 949-364-2778
Mailing address:
  • Phone: 949-715-5676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA104213
License Number StateCA

VIII. Authorized Official

Name: DR. DANIELLE KATHLEEN MOUL
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 949-715-5676