Healthcare Provider Details

I. General information

NPI: 1689644494
Provider Name (Legal Business Name): PATRICIA EBERT D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 10/30/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 VERDUGO BLVD # 152
MONTROSE CA
91020-1626
US

IV. Provider business mailing address

2029 VERDUGO BLVD # 152
MONTROSE CA
91020-1626
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-9399
  • Fax:
Mailing address:
  • Phone: 626-793-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC22655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: