Healthcare Provider Details

I. General information

NPI: 1912072422
Provider Name (Legal Business Name): JENNIFER LOUISE HOPPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 N SUNRISE AVE STE 100
ROSEVILLE CA
95661-2862
US

IV. Provider business mailing address

584 N SUNRISE AVE STE 100
ROSEVILLE CA
95661-2862
US

V. Phone/Fax

Practice location:
  • Phone: 916-773-2990
  • Fax: 916-773-5154
Mailing address:
  • Phone: 916-773-2990
  • Fax: 916-773-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA72295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: