Healthcare Provider Details

I. General information

NPI: 1700631934
Provider Name (Legal Business Name): CECILIA PATINO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6119 ZELZAH AVE
ENCINO CA
91316-7128
US

IV. Provider business mailing address

6119 ZELZAH AVE
ENCINO CA
91316-7128
US

V. Phone/Fax

Practice location:
  • Phone: 917-975-3426
  • Fax:
Mailing address:
  • Phone: 917-975-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95024740
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95024740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: