Healthcare Provider Details

I. General information

NPI: 1417499609
Provider Name (Legal Business Name): PATRICIA ELEY, L.E., CPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2016
Last Update Date: 11/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HIGH ST STE 201
AUBURN CA
95603-4734
US

IV. Provider business mailing address

701 HIGH ST STE 201
AUBURN CA
95603-4734
US

V. Phone/Fax

Practice location:
  • Phone: 530-613-0462
  • Fax:
Mailing address:
  • Phone: 530-613-0462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberL7332
License Number StateCA

VIII. Authorized Official

Name: MS. PATRICIA SUE ELEY
Title or Position: ELECTROLOGIST
Credential: L.E.,C.P.E
Phone: 530-613-0462