Provider Demographics
NPI:1902817158
Name:ISRAEL, MORTON PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:MORTON
Middle Name:PHILIP
Last Name:ISRAEL
Suffix:
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 1:770 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 1X
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3120
Mailing Address - Country:US
Mailing Address - Phone:951-734-9750
Mailing Address - Fax:951-734-3404
Practice Address - Street 1:770 MAGNOLIA AVE
Practice Address - Street 2:SUITE 1X
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3120
Practice Address - Country:US
Practice Address - Phone:951-734-9750
Practice Address - Fax:951-734-3404
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19795207W00000X
CA0788400001332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G197950Medicaid
A40757Medicare UPIN
CA00G197950Medicaid
CA0788400001Medicare NSC