Healthcare Provider Details

I. General information

NPI: 1245687359
Provider Name (Legal Business Name): AUDREY PATRICIO ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 W BURBANK BLVD
BURBANK CA
91506-1414
US

IV. Provider business mailing address

1122 W BURBANK BLVD
BURBANK CA
91506-1414
US

V. Phone/Fax

Practice location:
  • Phone: 818-736-9889
  • Fax: 800-830-0421
Mailing address:
  • Phone: 818-736-9889
  • Fax: 800-830-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: