Healthcare Provider Details

I. General information

NPI: 1780392654
Provider Name (Legal Business Name): LISA MICHELL MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 N WATERMAN AVE STE 1
SAN BERNARDINO CA
92404-5131
US

IV. Provider business mailing address

1738 N WATERMAN AVE STE 1
SAN BERNARDINO CA
92404-5131
US

V. Phone/Fax

Practice location:
  • Phone: 909-693-3302
  • Fax: 909-474-9610
Mailing address:
  • Phone: 909-693-3302
  • Fax: 909-494-7727

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
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: