Provider Demographics
NPI:1194195875
Name:MORALES-PHAN, CHRISTOPHER WAYNE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:MORALES-PHAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:WAYNE
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1782 W HAMMER LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-2922
Mailing Address - Country:US
Mailing Address - Phone:209-475-9500
Mailing Address - Fax:209-475-9559
Practice Address - Street 1:1782 W HAMMER LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2922
Practice Address - Country:US
Practice Address - Phone:209-475-9500
Practice Address - Fax:209-475-9559
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical