Provider Demographics
NPI:1912045303
Name:MORPHEUS ENTERPRISE, LTD
Entity Type:Organization
Organization Name:MORPHEUS ENTERPRISE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-535-7573
Mailing Address - Street 1:5 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-6050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 WESTMINSTER PL
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-6050
Practice Address - Country:US
Practice Address - Phone:510-535-7573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA709190207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A709191Medicare ID - Type Unspecified