Healthcare Provider Details

I. General information

NPI: 1255416715
Provider Name (Legal Business Name): GEORGE ROBERT MORO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE SUITE 830
ORANGE CA
92868-4223
US

IV. Provider business mailing address

1140 W LA VETA AVE SUITE 830
ORANGE CA
92868-4223
US

V. Phone/Fax

Practice location:
  • Phone: 714-836-1595
  • Fax: 714-836-1598
Mailing address:
  • Phone: 714-836-1595
  • Fax: 714-836-1598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberG64452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: