Healthcare Provider Details

I. General information

NPI: 1780042093
Provider Name (Legal Business Name): DARLENE MORRISSEY, D.O., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 S GRAND AVE SUITE 400
LOS ANGELES CA
90015-3070
US

IV. Provider business mailing address

1513 S GRAND AVE SUITE 400
LOS ANGELES CA
90015-3070
US

V. Phone/Fax

Practice location:
  • Phone: 213-742-6400
  • Fax: 213-765-4080
Mailing address:
  • Phone: 213-742-6400
  • Fax: 213-765-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number20A14075
License Number StateCA

VIII. Authorized Official

Name: DARLENE MORRISSEY
Title or Position: OWNER
Credential: D.O.
Phone: 215-518-9140