Provider Demographics
NPI:1528437332
Name:GEORGE R. MORO
Entity type:Organization
Organization Name:GEORGE R. MORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-836-1595
Mailing Address - Street 1:15707 ROCKFIELD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2838
Mailing Address - Country:US
Mailing Address - Phone:714-836-1595
Mailing Address - Fax:
Practice Address - Street 1:1140 W LA VETA AVE STE 830
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4230
Practice Address - Country:US
Practice Address - Phone:714-836-1595
Practice Address - Fax:714-836-1598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64452208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty