Provider Demographics
NPI:1154440873
Name:MORIN, JOSE P (CSA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:P
Last Name:MORIN
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 MARLYS AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133
Mailing Address - Country:US
Mailing Address - Phone:210-241-8433
Mailing Address - Fax:
Practice Address - Street 1:623 MARLYS AVE
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78133
Practice Address - Country:US
Practice Address - Phone:210-241-8433
Practice Address - Fax:877-334-0715
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2940246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist