Healthcare Provider Details

I. General information

NPI: 1881036093
Provider Name (Legal Business Name): PATRICIA DAUGHTREY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5024 3/4 HAYTER AVE
LAKEWOOD CA
90712-3105
US

IV. Provider business mailing address

5024 3/4 HAYTER AVE
LAKEWOOD CA
90712-3105
US

V. Phone/Fax

Practice location:
  • Phone: 562-333-5353
  • Fax:
Mailing address:
  • Phone: 562-333-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number396591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: