Provider Demographics
NPI:1013134162
Name:MORYL, COLLEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:MORYL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 S ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3603
Mailing Address - Country:US
Mailing Address - Phone:310-274-2148
Mailing Address - Fax:310-274-4431
Practice Address - Street 1:437 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3603
Practice Address - Country:US
Practice Address - Phone:310-274-2148
Practice Address - Fax:310-274-4431
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1307 & HA2975237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ56101ZOtherBLUE SHIELD
CAGAU000170Medicaid
CAAUD1307AMedicare PIN