Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003454695 |
---|---|
Provider Name | Kerry Morgan |
First Address | Rancho Cucamonga, CA 91730-4554 |
Second Address | Rancho Cucamonga, CA 91730-4554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2019 |
Last Update Date | 14/12/2019 |