Healthcare Provider Details

I. General information

NPI: 1891887089
Provider Name (Legal Business Name): JAMES MORAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/07/2023
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

IV. Provider business mailing address

1301 20TH ST STE 270
SANTA MONICA CA
90404-2053
US

V. Phone/Fax

Practice location:
  • Phone: 310-582-7312
  • Fax: 310-315-6118
Mailing address:
  • Phone: 310-828-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG13960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: