Healthcare Provider Details

I. General information

NPI: 1033040399
Provider Name (Legal Business Name): JAKE PATRICIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 BRYCE CT
EL DORADO HILLS CA
95762-7667
US

IV. Provider business mailing address

819 BRYCE CT
EL DORADO HILLS CA
95762-7667
US

V. Phone/Fax

Practice location:
  • Phone: 916-941-6791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: