Provider Demographics
NPI:1013314145
Name:MORTON P. ISRAEL, M.D.
Entity Type:Organization
Organization Name:MORTON P. ISRAEL, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORTON
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-734-9750
Mailing Address - Street 1:770 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 2D
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 2D
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG019795332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier