Provider Demographics
NPI:1609413509
Name:MORIEL, DAVID ANTHONY JR (AGACNP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANTHONY
Last Name:MORIEL
Suffix:JR
Gender:M
Credentials:AGACNP
Other - Prefix:
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Mailing Address - Street 1:1234 WILSHIRE BLVD APT 326
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1978
Mailing Address - Country:US
Mailing Address - Phone:323-793-1083
Mailing Address - Fax:
Practice Address - Street 1:1700 E. CESAR CHAVEZ AVE.
Practice Address - Street 2:2200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-9003
Practice Address - Country:US
Practice Address - Phone:323-268-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013357363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care