Healthcare Provider Details

I. General information

NPI: 1558474023
Provider Name (Legal Business Name): PATRICK THOMPSON N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD CMHS
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

250 BON AIR RD CMHS
GREENBRAE CA
94904-1702
US

V. Phone/Fax

Practice location:
  • Phone: 415-507-2961
  • Fax: 415-507-4113
Mailing address:
  • Phone: 415-473-2961
  • Fax: 415-507-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number503711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: