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NPI Code Detail

MEDICARE: DR. LORI ELLEN MOURATOFF M.D.

MEDICARE: DR. LORI ELLEN MOURATOFF M.D.
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
1207R00000XInternal Medicine PhysicianA64852CA

General Provider Information

NPI Number : 1790937506
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LORI ELLEN MOURATOFF M.D.
Provider Business Mailing Address
First Line : 188 CAPRICORN AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94611-1943
Country : US
Telephone Number : 510-326-4649
Fax Number : 510-848-9970
Provider Business Practice Location Address
First Line : 2905 TELEGRAPH AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94705-2017
Country : US
Telephone Number : 510-224-4181
Fax Number : 510-848-9970
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2008
Last Update Date : 06/10/2026

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