Provider Demographics
NPI:1912072422
Name:HOPPER, JENNIFER LOUISE (MD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LOUISE
Last Name:HOPPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 N SUNRISE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2862
Mailing Address - Country:US
Mailing Address - Phone:916-773-2990
Mailing Address - Fax:916-773-5154
Practice Address - Street 1:584 N SUNRISE AVE
Practice Address - Street 2:STE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2862
Practice Address - Country:US
Practice Address - Phone:916-773-2990
Practice Address - Fax:916-773-5154
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31141Medicare UPIN
CA00A722952Medicare ID - Type Unspecified