Healthcare Provider Details

I. General information

NPI: 1356569271
Provider Name (Legal Business Name): SARA CHRISTINE MORTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S TUSTIN ST
ORANGE CA
92866-3425
US

IV. Provider business mailing address

601 W 19TH ST SUITE
COSTA MESA CA
92627-5060
US

V. Phone/Fax

Practice location:
  • Phone: 714-922-4100
  • Fax:
Mailing address:
  • Phone: 714-922-4100
  • Fax: 949-548-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: