Michael Scott Mortensen, PHYSICIAN ASSISTANT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

56485 Issued in CA

Practice address

425 Haaland Dr Ste 102
Thousand Oaks, CA 91361-5230

Phone

(805) 723-8008

NPI assigned

Jul 24, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563926400000",
    "number": "1124671532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3713 CORTE DE LOS REYES",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913607025",
            "telephone_number": "805-529-3475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 HAALAND DR STE 102",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913615230",
            "telephone_number": "805-723-8008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSEN",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-24",
        "last_updated": "2019-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "56485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan F. Morris, M.D.
• Kisun Morris
• Mary Welby Morris
• David Alan Morrison, PSY.D
• Martin Mazyar Mortazavi Shemirani, M.D.
• Rachel Patricia Mory, MD
• Irit Moryles, BPT
• Brooke Moser
• Catherine A Moses, MD
• Corinna Mosher, M.D.

• Medical Physician Assistant in Thousand Oaks, CA
• Providers in Thousand Oaks, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.