Provider Demographics
NPI:1962195792
Name:MORGAN, ANGELA (RD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 W CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5725
Mailing Address - Country:US
Mailing Address - Phone:818-314-0971
Mailing Address - Fax:
Practice Address - Street 1:1215 W CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5725
Practice Address - Country:US
Practice Address - Phone:818-314-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1105567133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered