=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679647069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOEL MARK MORRIS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13324 W. WASHINGTON BLVD SUITE 202
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-422-4564
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 134 SAN VICENTE BLVD APT. A
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90402-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-422-4564
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | C51388
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------