Provider Demographics
NPI:1164281044
Name:STICKNEY, MORGAN L (RS, CSO, CDCES)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:L
Last Name:STICKNEY
Suffix:
Gender:F
Credentials:RS, CSO, CDCES
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:BOWNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3075 HEALTH CENTER DR FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2773
Mailing Address - Country:US
Mailing Address - Phone:858-939-4870
Mailing Address - Fax:
Practice Address - Street 1:3075 HEALTH CENTER DR FL 4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2773
Practice Address - Country:US
Practice Address - Phone:858-939-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered