Healthcare Provider Details

I. General information

NPI: 1144581364
Provider Name (Legal Business Name): SEAN MICHAEL MORAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E 4TH ST SECOND FLOOR
SANTA ANA CA
92705-3962
US

IV. Provider business mailing address

1900 E 4TH ST SECOND FLOO
SANTA ANA CA
92705-3962
US

V. Phone/Fax

Practice location:
  • Phone: 714-644-6480
  • Fax: 714-967-4575
Mailing address:
  • Phone: 714-644-6480
  • Fax: 714-967-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA143189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: