Provider Demographics
NPI:1225010663
Name:MORGUELAN, BARRY A (MD INC)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:A
Last Name:MORGUELAN
Suffix:
Gender:M
Credentials:MD INC
Other - Prefix:
Other - First Name:BARRY
Other - Middle Name:A
Other - Last Name:MORGUELAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD INC
Mailing Address - Street 1:201 S ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2386
Mailing Address - Country:US
Mailing Address - Phone:213-413-5010
Mailing Address - Fax:213-413-7734
Practice Address - Street 1:201 S ALVARADO ST
Practice Address - Street 2:#602
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2320
Practice Address - Country:US
Practice Address - Phone:213-413-5010
Practice Address - Fax:213-413-7734
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27009207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G270090Medicaid
CA00G270090Medicaid
CA00G270090Medicaid