Healthcare Provider Details

I. General information

NPI: 1477417491
Provider Name (Legal Business Name): EDEN BAILEY MORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 N PARAMOUNT BLVD
LONG BEACH CA
90805-3711
US

IV. Provider business mailing address

364 CORONADO AVE
LONG BEACH CA
90814-2613
US

V. Phone/Fax

Practice location:
  • Phone: 562-630-8672
  • Fax:
Mailing address:
  • Phone: 209-402-1829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: