Provider Demographics
NPI:1790001725
Name:MORLEY, MICHAEL ROBERT (MPA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:MORLEY
Suffix:
Gender:M
Credentials:MPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2832
Mailing Address - Country:US
Mailing Address - Phone:510-529-1648
Mailing Address - Fax:
Practice Address - Street 1:3035 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2204
Practice Address - Country:US
Practice Address - Phone:831-688-8680
Practice Address - Fax:831-661-0136
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20934363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant