Provider Demographics
NPI:1194370338
Name:SOURAPAS, ASHLEE NICOLE-MORTON (LM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEE
Middle Name:NICOLE-MORTON
Last Name:SOURAPAS
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:ASHLEE
Other - Middle Name:NICOLE
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22672 LAMBERT STREET
Mailing Address - Street 2:SUITE 611
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630
Mailing Address - Country:US
Mailing Address - Phone:714-261-1458
Mailing Address - Fax:949-954-8398
Practice Address - Street 1:22672 LAMBERT STREET
Practice Address - Street 2:SUITE 611
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630
Practice Address - Country:US
Practice Address - Phone:714-261-1458
Practice Address - Fax:949-954-8398
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM577176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife