Healthcare Provider Details

I. General information

NPI: 1073269098
Provider Name (Legal Business Name): JOHN PATRICK MORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13631 JEREMY CT
RANCHO CUCAMONGA CA
91739-2031
US

IV. Provider business mailing address

10447 MANGROVE ST
RANCHO CUCAMONGA CA
91730-1721
US

V. Phone/Fax

Practice location:
  • Phone: 909-803-0601
  • Fax:
Mailing address:
  • Phone: 909-660-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: