Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A15880 | CA |
NPI | 1003278029 |
---|---|
Provider Name | Lynnea Wilson Morm |
First Address | Harbor City, CA 90710-2084 |
Second Address | Harbor City, CA 90710-2084 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 07/01/2020 |