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General NPI Number Information
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NPI Number | 1902817158
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Entity Type | Individual
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Provider Name | MORTON PHILIP ISRAEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 11/09/2007
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Provider Practice Location Address
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Address Line | 770 MAGNOLIA AVE SUITE 1X
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City | CORONA
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State | CA
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Zip | 92879-3120
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Country | US
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Telephone | 951-734-9750
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Fax | 951-734-3404
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Provider Business Mailing Address
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Address Line | 770 MAGNOLIA AVE SUITE 1X
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City | CORONA
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State | CA
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Zip | 92879-3120
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Country | US
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Telephone | 951-734-9750
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Fax | 951-734-3404
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G19795
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 0788400001
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License Number State | CA
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