Healthcare Provider Details

I. General information

NPI: 1881031896
Provider Name (Legal Business Name): MARK R PATRAS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WILLOW PASS RD SUITE 200
CONCORD CA
94520-5823
US

IV. Provider business mailing address

NA NA
NA NA
NA
NA

V. Phone/Fax

Practice location:
  • Phone: 925-646-5480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number677743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: