MEDICARE: KATRINE MOREALE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	43462	CO
2	207Q00000X	Family Medicine Physician	C55293	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	016715	OTHER		KAISER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1770613531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINE MOREALE MD

Provider Business Mailing Address
First Line	:	1403 LOMITA BLVD
Second Line	:	2ND FLOOR
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2076
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1403 LOMITA BLVD
Second Line	:	2ND FLOOR
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2076
Country	:	US
Telephone Number	:	310-257-4991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	04/19/2021

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Directions to “ KATRINE MOREALE MD” Practice Location

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