Provider Demographics
NPI:1790417723
Name:MOROPOULOS, PEYTON MICHELLE
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:MICHELLE
Last Name:MOROPOULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 SAN CLEMENTE WAY
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1246
Mailing Address - Country:US
Mailing Address - Phone:805-280-6404
Mailing Address - Fax:
Practice Address - Street 1:1320 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2926
Practice Address - Country:US
Practice Address - Phone:305-284-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer