MEDICARE: MARIA CRISTINA PATRICIO

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1922351006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA CRISTINA PATRICIO

Provider Business Mailing Address
First Line	:	6651 BECK AVE APT 3
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 N ALAMEDA ST # 350
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1804
Country	:	US
Telephone Number	:	323-921-6689
Fax Number	:

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

Provider Enumeration Date	:	10/26/2012
Last Update Date	:	10/26/2012

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Directions to “ MARIA CRISTINA PATRICIO ” Practice Location

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