Provider Demographics
NPI:1992453195
Name:MORAN, ERICA LYNN (PA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:MORAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23501 CINEMA DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5428
Mailing Address - Country:US
Mailing Address - Phone:612-583-8116
Mailing Address - Fax:
Practice Address - Street 1:23501 CINEMA DR STE 111
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5429
Practice Address - Country:US
Practice Address - Phone:661-258-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA62506363A00000X
NVPA2616363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant