MEDICARE: TYLLINE ANGELIE MORGAN LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	259805	CA

General Provider Information

NPI Number	:	1689938227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLLINE ANGELIE MORGAN LVN

Provider Business Mailing Address
First Line	:	1343 HIGHLAND AVE APT A
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-3537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2456 E ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-2024
Country	:	US
Telephone Number	:	619-320-4813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2012
Last Update Date	:	06/28/2012

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