Healthcare Provider Details

I. General information

NPI: 1013175611
Provider Name (Legal Business Name): CHARLES J MORAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1763 RAMADA DRIVE
PASO ROBLES CA
93446
US

IV. Provider business mailing address

1763 RAMADA DRIVE
PASO ROBLES CA
93446
US

V. Phone/Fax

Practice location:
  • Phone: 805-226-0902
  • Fax: 805-226-0905
Mailing address:
  • Phone: 805-226-0902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberC3076452
License Number StateCA

VIII. Authorized Official

Name: DR. CHARLES J. MORAN
Title or Position: OWNER
Credential: MD
Phone: 805-226-0902