Provider Demographics
NPI:1003157280
Name:MORGAN, ELYSIA NICOLE (BA)
Entity Type:Individual
Prefix:
First Name:ELYSIA
Middle Name:NICOLE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 1/2 W 147TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-2806
Mailing Address - Country:US
Mailing Address - Phone:310-405-4184
Mailing Address - Fax:
Practice Address - Street 1:1751 CLOVERFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4007
Practice Address - Country:US
Practice Address - Phone:310-450-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program