Provider Demographics
NPI:1619919180
Name:MORADA, FELCAR PHIL (MD)
Entity Type:Individual
Prefix:DR
First Name:FELCAR
Middle Name:PHIL
Last Name:MORADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FELCAR
Other - Middle Name:LUISTRO
Other - Last Name:MORADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7709 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2120
Mailing Address - Country:US
Mailing Address - Phone:818-352-3146
Mailing Address - Fax:818-352-8116
Practice Address - Street 1:7709 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2120
Practice Address - Country:US
Practice Address - Phone:818-352-3146
Practice Address - Fax:818-352-8116
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100020Medicaid
CAZZZ66291ZOtherBLUE SHIELD CA
CAW18496OtherMEDICARE PTAN
CAP00342643OtherRAILROAD MC
CAA27968Medicare UPIN
CAZZZ66291ZOtherBLUE SHIELD CA