Healthcare Provider Details

I. General information

NPI: 1689970139
Provider Name (Legal Business Name): PATRICA COLLINS CO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 40TH ST 1ST FLOOR
OAKLAND CA
94609-2691
US

IV. Provider business mailing address

693 HI TECH PKWY
OAKDALE CA
95361-9372
US

V. Phone/Fax

Practice location:
  • Phone: 510-653-9834
  • Fax: 510-653-9037
Mailing address:
  • Phone: 209-845-8231
  • Fax: 209-845-2883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: