Provider Demographics
NPI:1699066282
Name:S.E. MOORTHY, M.D., INC.
Entity type:Organization
Organization Name:S.E. MOORTHY, M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SINNADURAI
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, GI
Authorized Official - Phone:661-916-1144
Mailing Address - Street 1:1541 N CHINA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-2606
Mailing Address - Country:US
Mailing Address - Phone:760-446-3800
Mailing Address - Fax:760-446-3711
Practice Address - Street 1:1541 N CHINA LAKE BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2606
Practice Address - Country:US
Practice Address - Phone:760-446-3800
Practice Address - Fax:760-446-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFL735AMedicare PIN