Provider Demographics
NPI:1053341909
Name:MORELLO, PAUL JOSEPH (DPM)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:MORELLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15048 QUAIL VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-2231
Mailing Address - Country:US
Mailing Address - Phone:619-922-8449
Mailing Address - Fax:619-443-7476
Practice Address - Street 1:15048 QUAIL VALLEY WAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-2231
Practice Address - Country:US
Practice Address - Phone:619-922-8449
Practice Address - Fax:619-443-7476
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2659213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11426Medicare UPIN
CAE2659Medicare PIN