Healthcare Provider Details

I. General information

NPI: 1467030478
Provider Name (Legal Business Name): MARIA DE LOS ANGELES MOREIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18221 E 17TH ST
SANTA ANA CA
92705-2676
US

IV. Provider business mailing address

18221 E 17TH ST
SANTA ANA CA
92705-2676
US

V. Phone/Fax

Practice location:
  • Phone: 714-730-0930
  • Fax:
Mailing address:
  • Phone: 714-730-0930
  • Fax: 714-730-3487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: