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General NPI Number Information
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NPI Number | 1306604889
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Entity Type | Individual
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Provider Name | KIMYATTA MORRIS
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Gender | Female
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 333 CEDAR ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-3206
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Country | US
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Telephone | 203-432-4771
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Fax |
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Provider Business Mailing Address
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Address Line | 25210 COPA DEL ORO DR UNIT 204
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City | HAYWARD
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State | CA
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Zip | 94545-2586
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Country | US
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Telephone | 510-396-2508
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | CA
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