Provider Demographics
NPI:1538277819
Name:MORRIS-LOPEZ, JACQUELINE (PA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MORRIS-LOPEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 GREEN VALLEY RD.
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-2516
Mailing Address - Country:US
Mailing Address - Phone:831-319-4194
Mailing Address - Fax:831-319-4198
Practice Address - Street 1:108 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019
Practice Address - Country:US
Practice Address - Phone:831-319-4194
Practice Address - Fax:831-314-4198
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN3144198OtherDRIVER LICENSE
CAN3144198OtherDRIVER LICENSE
CAZZZ15685ZMedicare ID - Type UnspecifiedCOUNTY OF MONTEREY GROUP