Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003320748 |
---|---|
Provider Name | Thomas Earl Morningstar |
First Address | Los Angeles, CA 90045-3945 |
Second Address | Los Angeles, CA 90045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2017 |
Last Update Date | 24/12/2019 |