Provider Demographics
NPI:1659915312
Name:MCELWEE-DUHAMEL, MORGAN BRIAN
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:BRIAN
Last Name:MCELWEE-DUHAMEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 MELBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3532
Mailing Address - Country:US
Mailing Address - Phone:858-395-6659
Mailing Address - Fax:
Practice Address - Street 1:8717 FLETCHER PKWY APT 351
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3243
Practice Address - Country:US
Practice Address - Phone:619-251-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3487376OtherDRIVER LICENSE