=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710012158
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA F MORALES NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 896 S HARBOR BLVD
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92805-5158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-691-3247
-----------------------------------------------------
Fax | 562-691-8296
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 896 S HARBOR BLVD
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92805-5158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-691-3247
-----------------------------------------------------
Fax | 562-691-8296
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | NP006913
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------