Healthcare Provider Details

I. General information

NPI: 1316696461
Provider Name (Legal Business Name): IAN PAOLO MORELOS MAURICIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

3800 W CHAPMAN AVE STE 3200
ORANGE CA
92868-1638
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8008
  • Fax:
Mailing address:
  • Phone: 617-414-4929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA209759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: