Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY10682 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY10682 | CA |
NPI | 1003922089 |
---|---|
Provider Name | George Morrera |
First Address | Simi Valley, CA 93065-6508 |
Second Address | Simi Valley, CA 93065-6508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PS4106820 | (05) | CA |