Healthcare Provider Details

I. General information

NPI: 1104846567
Provider Name (Legal Business Name): LUCILA KAROL MOREIRA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 VISTA WAY BLDG B
OCEANSIDE CA
92056-4565
US

IV. Provider business mailing address

3880 MURPHY CANYON RD STE 200
SAN DIEGO CA
92123-4411
US

V. Phone/Fax

Practice location:
  • Phone: 760-547-1010
  • Fax: 760-547-1011
Mailing address:
  • Phone: 858-636-4300
  • Fax: 858-636-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number240504
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS11047
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: