Provider Demographics
NPI:1295816338
Name:MORGAN, SHIRI
Entity Type:Individual
Prefix:
First Name:SHIRI
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5632
Mailing Address - Country:US
Mailing Address - Phone:310-794-1503
Mailing Address - Fax:310-267-1899
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:#530
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90074
Practice Address - Country:US
Practice Address - Phone:310-794-1503
Practice Address - Fax:310-267-1899
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA897405133V00000X, 133NN1002X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ60059Medicare UPIN
CAWNT897405AMedicare PIN