Healthcare Provider Details

I. General information

NPI: 1306444880
Provider Name (Legal Business Name): AZUSA MORIMOTO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 08/28/2023
Certification Date: 08/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 DEEP VALLEY DR STE 200
ROLLING HILLS ESTATES CA
90274-3614
US

IV. Provider business mailing address

609 DEEP VALLEY DR. SUITE 200
ROLLING HILLS ESTATES CA
90274-1840
US

V. Phone/Fax

Practice location:
  • Phone: 310-795-7327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10200196
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: