Provider Demographics
NPI:1588689798
Name:MORTON, VICTOR GENE (PHD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:GENE
Last Name:MORTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 WESTWOOD BLVD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2940
Mailing Address - Country:US
Mailing Address - Phone:310-826-5123
Mailing Address - Fax:
Practice Address - Street 1:941 WESTWOOD BLVD.
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2940
Practice Address - Country:US
Practice Address - Phone:310-826-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8286103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8286Medicare ID - Type Unspecified