Provider Demographics
NPI:1831678978
Name:MORRISON, DELSIE IRENE
Entity Type:Individual
Prefix:
First Name:DELSIE
Middle Name:IRENE
Last Name:MORRISON
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 1:200 OCEANGATE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-435-3666
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:400 TIJERAS AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3252
Practice Address - Country:US
Practice Address - Phone:888-562-5442
Practice Address - Fax:562-499-6141
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM53576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine