Healthcare Provider Details

I. General information

NPI: 1194195875
Provider Name (Legal Business Name): CHRISTOPHER WAYNE MORALES-PHAN P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. CHRISTOPHER WAYNE MORALES

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 LAGUNA BLVD STE 113
ELK GROVE CA
95758-7902
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-478-6561
  • Fax: 916-478-6573
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA52986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: