1073345591 NPI number — HAELI SIERRA MORRIS CMT #95318

Table of content: HAELI SIERRA MORRIS CMT #95318 (NPI 1073345591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073345591 NPI number — HAELI SIERRA MORRIS CMT #95318

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRIS
Provider First Name:
HAELI
Provider Middle Name:
SIERRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CMT #95318
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEYER
Provider Other First Name:
HAELI
Provider Other Middle Name:
SIERRA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MARRIED NAME
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073345591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 BOHEMIAN HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEBASTOPOL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95472-9578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-600-2986
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FIRST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCCIDENTAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-600-2986
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  95318 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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