Healthcare Provider Details

I. General information

NPI: 1790457414
Provider Name (Legal Business Name): MS. RACHEL ARIEL MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 INDIANA ST
SAN FRANCISCO CA
94107-3406
US

IV. Provider business mailing address

1234 INDIANA ST
SAN FRANCISCO CA
94107-3406
US

V. Phone/Fax

Practice location:
  • Phone: 415-282-9675
  • Fax:
Mailing address:
  • Phone: 415-282-9675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: