Provider Demographics
NPI:1114049285
Name:MOORE, MIKA (AUD)
Entity Type:Individual
Prefix:
First Name:MIKA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MIKA
Other - Middle Name:
Other - Last Name:WINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1301 W PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3808
Mailing Address - Country:US
Mailing Address - Phone:714-923-1527
Mailing Address - Fax:714-744-3841
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:STE. 190
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-548-0352
Practice Address - Fax:949-548-4839
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1873237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA3913OtherHEARING AID DISPENSER
CAAU1873OtherSTATE LICENSE