Healthcare Provider Details

I. General information

NPI: 1114049285
Provider Name (Legal Business Name): MIKA MOORE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIKA WINKLE AU.D.

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE. 190
NEWPORT BEACH CA
92663-3637
US

IV. Provider business mailing address

1301 W PROVIDENCE AVE
ORANGE CA
92868-3808
US

V. Phone/Fax

Practice location:
  • Phone: 949-548-0352
  • Fax: 949-548-4839
Mailing address:
  • Phone: 714-923-1527
  • Fax: 714-744-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: