Provider Demographics
NPI:1639673635
Name:MORAN, GEORGE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:MORAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 MONTE VISTA AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2231
Mailing Address - Country:US
Mailing Address - Phone:909-626-1205
Mailing Address - Fax:909-399-9265
Practice Address - Street 1:9525 MONTE VISTA AVE STE 105
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2231
Practice Address - Country:US
Practice Address - Phone:909-626-1205
Practice Address - Fax:909-399-9265
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174848207R00000X, 207R00000X
CAPTL3434390200000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program