Healthcare Provider Details

I. General information

NPI: 1649114422
Provider Name (Legal Business Name): PATRICIA LAUREN TILLOTSON CPT-1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 UNION ST
ARCATA CA
95521-6044
US

IV. Provider business mailing address

600 F ST STE 3
ARCATA CA
95521-6301
US

V. Phone/Fax

Practice location:
  • Phone: 707-630-1844
  • Fax:
Mailing address:
  • Phone: 707-630-1844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT-00019340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: