Healthcare Provider Details

I. General information

NPI: 1205364536
Provider Name (Legal Business Name): PATRICE DOLORES NEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MORELLO AVE STE 100
MARTINEZ CA
94553-4707
US

IV. Provider business mailing address

1340 ARNOLD DR STE 200
MARTINEZ CA
94553-4189
US

V. Phone/Fax

Practice location:
  • Phone: 925-957-2615
  • Fax: 925-957-2620
Mailing address:
  • Phone: 925-957-5150
  • Fax: 925-957-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number400049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: