Provider Demographics
NPI:1518507698
Name:MORAN, REINA D (NP)
Entity Type:Individual
Prefix:
First Name:REINA
Middle Name:D
Last Name:MORAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14550 HAYNES ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1613
Mailing Address - Country:US
Mailing Address - Phone:818-650-6700
Mailing Address - Fax:
Practice Address - Street 1:1401 W 1ST ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3757
Practice Address - Country:US
Practice Address - Phone:714-542-9700
Practice Address - Fax:714-542-9708
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily