Healthcare Provider Details

I. General information

NPI: 1962820076
Provider Name (Legal Business Name): PATRICK WEST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6117 MARTIN LUTHER KING JR WAY
OAKLAND CA
94609-1240
US

IV. Provider business mailing address

6688 SPRUCE LN
DUBLIN CA
94568-2523
US

V. Phone/Fax

Practice location:
  • Phone: 510-655-4896
  • Fax:
Mailing address:
  • Phone: 209-610-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: