Provider Demographics
NPI:1215121413
Name:MORIN MEDICAL CORP.
Entity type:Organization
Organization Name:MORIN MEDICAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-484-7448
Mailing Address - Street 1:2103 PICKWICK DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6427
Mailing Address - Country:US
Mailing Address - Phone:805-484-7448
Mailing Address - Fax:805-484-3642
Practice Address - Street 1:2103 PICKWICK DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6427
Practice Address - Country:US
Practice Address - Phone:805-484-7448
Practice Address - Fax:805-484-3642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66380Medicare UPIN