Healthcare Provider Details

I. General information

NPI: 1972966406
Provider Name (Legal Business Name): NATHANIEL MORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST
SAN QUENTIN CA
94964-1000
US

IV. Provider business mailing address

1 MAIN ST
SAN QUENTIN CA
94964-1000
US

V. Phone/Fax

Practice location:
  • Phone: 415-454-1460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA151672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: