Healthcare Provider Details

I. General information

NPI: 1124965462
Provider Name (Legal Business Name): IAN PATTON PPSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 FLEMING AVE
OAKLAND CA
94619-2515
US

IV. Provider business mailing address

1412 E 38TH ST
OAKLAND CA
94602-1125
US

V. Phone/Fax

Practice location:
  • Phone: 510-879-2152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number210221982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: