Healthcare Provider Details

I. General information

NPI: 1083302715
Provider Name (Legal Business Name): MARCOS JOSE HENRIQUEZ MORALES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARCOS JOSE HENRIQUEZ MD

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

IV. Provider business mailing address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

V. Phone/Fax

Practice location:
  • Phone: 916-688-2106
  • Fax:
Mailing address:
  • Phone: 916-688-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number212219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: