Provider Demographics
NPI:1972710440
Name:MORALES, ROSS (PA-C)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 E COAST HWY # 219
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2404
Mailing Address - Country:US
Mailing Address - Phone:949-244-9471
Mailing Address - Fax:
Practice Address - Street 1:3535 E COAST HWY # 219
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2404
Practice Address - Country:US
Practice Address - Phone:949-244-9471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14355363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant