Provider Demographics
NPI:1003528324
Name:MANLEY, MORGAN MARIE (IDC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:MARIE
Last Name:MANLEY
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 WESTWARD HO CIR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-3721
Mailing Address - Country:US
Mailing Address - Phone:330-749-8505
Mailing Address - Fax:
Practice Address - Street 1:22 AREA MEDICAL CLINIC
Practice Address - Street 2:BLDG 22190
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5750
Practice Address - Country:US
Practice Address - Phone:330-749-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman