Provider Demographics
NPI:1699758128
Name:MOORMAN, RITA M (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:MOORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:800-883-7243
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:280 S MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3852
Practice Address - Country:US
Practice Address - Phone:714-704-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50801207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A508011Medicaid
CACB237490Medicare PIN
CAA50801AMedicare PIN
CA050022138Medicare PIN
CACB237491Medicare PIN
CA00A508011Medicaid
CAWA50801BMedicare PIN
CABZ696AMedicare PIN
CABU525XMedicare PIN
CA050088197Medicare PIN
CABZ696BMedicare PIN
CABU525ZMedicare PIN