Healthcare Provider Details

I. General information

NPI: 1831678978
Provider Name (Legal Business Name): DELSIE IRENE MORRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TIJERAS AVE NW STE 200
ALBUQUERQUE NM
87102-3252
US

IV. Provider business mailing address

200 OCEANGATE STE 100
LONG BEACH CA
90802-4317
US

V. Phone/Fax

Practice location:
  • Phone: 888-562-5442
  • Fax: 562-499-6141
Mailing address:
  • Phone: 562-435-3666
  • Fax: 562-499-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53576
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: