Provider Demographics
NPI:1447076427
Name:MORGAN, MALLORY ELYSE (RD)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:ELYSE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:ELYSE
Other - Last Name:DOOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:8010 FROST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4222
Mailing Address - Country:US
Mailing Address - Phone:858-650-5053
Mailing Address - Fax:
Practice Address - Street 1:8010 FROST ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4222
Practice Address - Country:US
Practice Address - Phone:858-650-5053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86033257133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered