Provider Demographics
NPI:1881745701
Name:MORGUELAN, FRED N (PHD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:N
Last Name:MORGUELAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 TOWNSGATE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2405
Mailing Address - Country:US
Mailing Address - Phone:805-495-5666
Mailing Address - Fax:805-495-5066
Practice Address - Street 1:2239 TOWNSGATE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2405
Practice Address - Country:US
Practice Address - Phone:805-495-5666
Practice Address - Fax:805-495-5066
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical