Healthcare Provider Details

I. General information

NPI: 1932317765
Provider Name (Legal Business Name): STEPHANIE MORTON MORIARTY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 CHILDRENS WAY SUITE 202
SAN DIEGO CA
92123-4232
US

IV. Provider business mailing address

15534 OAKSTAND RD
POWAY CA
92064-2262
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-8030
  • Fax: 858-966-8032
Mailing address:
  • Phone: 858-966-8030
  • Fax: 858-966-8032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: