Healthcare Provider Details

I. General information

NPI: 1114581543
Provider Name (Legal Business Name): ZACHARY WILLIAM PATINKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 07/04/2022
Certification Date: 07/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR # MC0965
LA JOLLA CA
92093-0001
US

IV. Provider business mailing address

9500 GILMAN DR # MC0965
LA JOLLA CA
92093-5004
US

V. Phone/Fax

Practice location:
  • Phone: 858-822-4434
  • Fax:
Mailing address:
  • Phone: 617-671-5985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA179546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: