Healthcare Provider Details

I. General information

NPI: 1851008635
Provider Name (Legal Business Name): LILLIAM GUIA MORRISON BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE
BERKELEY CA
94705-2067
US

IV. Provider business mailing address

688 AMADOR ST
RICHMOND CA
94805-1957
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-4444
  • Fax:
Mailing address:
  • Phone: 510-830-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95227096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: