MEDICARE: MICHAEL WILLIAM PATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	283866	CA
2	163WC1500X	Community Health Registered Nurse	283866	CA

General Provider Information

NPI Number	:	1073322392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WILLIAM PATE

Provider Business Mailing Address
First Line	:	2763 ADRIAN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5712
Country	:	US
Telephone Number	:	619-357-9743
Fax Number	:

Provider Business Practice Location Address
First Line	:	3914 MURPHY CANYON RD STE A226
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4436
Country	:	US
Telephone Number	:	31-585-8751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2025
Last Update Date	:	01/01/2025

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