Basic Information
| Provider Information | |||||||||
| NPI: | 1073943551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORAN | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | MARGARET | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7675 DAGGET ST STE 370 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921112260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583096585 | ||||||||
| FaxNumber: | 8583096593 | ||||||||
| Practice Location | |||||||||
| Address1: | 477 N EL CAMINO REAL | ||||||||
| Address2: | STE. D200 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920241328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607478935 | ||||||||
| FaxNumber: | 7604523344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2013 | ||||||||
| LastUpdateDate: | 05/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 95083773 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 111603 | NE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | MM3108936 | 01 | CA | DEA LICENSE | OTHER | 95083773 | 01 | CA | MEDICAL LICENSE | OTHER |