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General NPI Number Information
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NPI Number | 1164955407
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Entity Type | Individual
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Provider Name | IRENE MORIDI
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Gender | Female
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 9835 N LAKE CREEK PKWY
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City | AUSTIN
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State | TX
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Zip | 78717-6210
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Country | US
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Telephone | 737-229-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 KINGSLEY AVE STE 390
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City | ORANGE PARK
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State | FL
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Zip | 32073-4484
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Country | US
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Telephone | 904-639-2260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | C1-0028447
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | T4559
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 13389
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD210001941
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License Number State | DC
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Taxonomy #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME161977
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | T4559
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | MD489965C
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License Number State | PA
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