Provider Demographics
NPI:1932317765
Name:MORIARTY, STEPHANIE MORTON (NP)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MORTON
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15534 OAKSTAND RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2262
Mailing Address - Country:US
Mailing Address - Phone:858-966-8030
Mailing Address - Fax:858-966-8032
Practice Address - Street 1:3030 CHILDRENS WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4232
Practice Address - Country:US
Practice Address - Phone:858-966-8030
Practice Address - Fax:858-966-8032
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11137363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA284719OtherRN
CA11137OtherNURSE PRACTITIONER