Provider Demographics
NPI:1538593801
Name:MORGAN, MICHAEL (CS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 W HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4010
Mailing Address - Country:US
Mailing Address - Phone:818-823-0468
Mailing Address - Fax:
Practice Address - Street 1:4132 W HOOD AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4010
Practice Address - Country:US
Practice Address - Phone:818-823-0468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB8370850374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner