Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | PENDING | CA |
Y | 207RH0002X | Hospice and Palliative Medicine | 000000000000000 | CA |
N | 207RH0002X | Hospice and Palliative Medicine | PENDING | CA |
NPI | 1699439943 |
---|---|
Provider Name | Mr. Randall Morton |
First Address | Fountain Valley, CA 92708-6770 |
Second Address | Fountain Valley, CA 92708-6770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2021 |
Last Update Date | 22/10/2021 |