Healthcare Provider Details

I. General information

NPI: 1831086347
Provider Name (Legal Business Name): PATRICIA FAGUNDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 HILDA CT
BRENTWOOD CA
94513-5236
US

IV. Provider business mailing address

2133 HILDA CT
BRENTWOOD CA
94513-5236
US

V. Phone/Fax

Practice location:
  • Phone: 510-461-9168
  • Fax:
Mailing address:
  • Phone: 510-461-9168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95172859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: