Provider Demographics
NPI:1053292383
Name:LLEWELLYN, MORGAN
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:LLEWELLYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BAY AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2103
Mailing Address - Country:US
Mailing Address - Phone:831-854-2060
Mailing Address - Fax:408-604-0214
Practice Address - Street 1:820 BAY AVE STE 212
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2103
Practice Address - Country:US
Practice Address - Phone:831-854-2060
Practice Address - Fax:408-604-0214
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21290390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program