Healthcare Provider Details

I. General information

NPI: 1518507698
Provider Name (Legal Business Name): REINA D MORAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W 1ST ST STE 101
SANTA ANA CA
92703-3757
US

IV. Provider business mailing address

14550 HAYNES ST
VAN NUYS CA
91411-1613
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-9700
  • Fax: 714-542-9708
Mailing address:
  • Phone: 818-650-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: