Healthcare Provider Details

I. General information

NPI: 1679009856
Provider Name (Legal Business Name): MORGAN SURFAS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2017
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NEWPORT CENTER DR STE 150
NEWPORT BEACH CA
92660-6418
US

IV. Provider business mailing address

PO BOX 7494
HUNTINGTON BEACH CA
92615-7494
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-3312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number54414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: