Healthcare Provider Details

I. General information

NPI: 1275018210
Provider Name (Legal Business Name): PATTI PICKLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W LA VETA AVE STE 101
ORANGE CA
92868-3928
US

IV. Provider business mailing address

805 W LA VETA AVE STE 101
ORANGE CA
92868-3928
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-9595
  • Fax:
Mailing address:
  • Phone: 713-248-2028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP138855
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: