MEDICARE: ZACHARY PATTERSON BSN, RN, PHN

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	390200000X	Student in an Organized Health Care Education/Training Program
2	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	95288387	CA

General Provider Information

NPI Number	:	1730041468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY PATTERSON BSN, RN, PHN

Provider Business Mailing Address
First Line	:	1752 E LUGONIA AVE # 117-17
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-2730
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1752 E LUGONIA AVE # 117-17
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-2730
Country	:	US
Telephone Number	:	909-213-9488
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	02/11/2026

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