Healthcare Provider Details

I. General information

NPI: 1013096585
Provider Name (Legal Business Name): DONALD MORLEY NULL, JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD NICU
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2516 STOCKTON BLVD DEPT. OF PEDIATRICS
SACRAMENTO CA
95817-2208
US

V. Phone/Fax

Practice location:
  • Phone: 916-703-3050
  • Fax: 916-703-3055
Mailing address:
  • Phone: 916-734-3891
  • Fax: 916-456-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number378985-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberG135717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: