Provider Demographics
NPI:1255494076
Name:MORRIS, CARMEN (BA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:MORRIS
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 1:175 W LA VERNE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2347
Mailing Address - Country:US
Mailing Address - Phone:909-392-0302
Mailing Address - Fax:909-392-0216
Practice Address - Street 1:175 W LA VERNE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2347
Practice Address - Country:US
Practice Address - Phone:909-392-0302
Practice Address - Fax:909-392-0216
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2036237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist