Provider Demographics
NPI:1033659388
Name:GILFILLAN, MORGAN IRENE (STUDENT)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:IRENE
Last Name:GILFILLAN
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 HORNBLEND ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4329
Mailing Address - Country:US
Mailing Address - Phone:925-784-5781
Mailing Address - Fax:
Practice Address - Street 1:1420 HORNBLEND ST
Practice Address - Street 2:APT. 1
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4329
Practice Address - Country:US
Practice Address - Phone:925-784-5781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program