Healthcare Provider Details

I. General information

NPI: 1649067430
Provider Name (Legal Business Name): MARYANNE A PATTON CMT#1589
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 DAHLBERG DR
PACIFICA CA
94044-2211
US

IV. Provider business mailing address

33 DAHLBERG DR
PACIFICA CA
94044-2211
US

V. Phone/Fax

Practice location:
  • Phone: 650-544-9861
  • Fax:
Mailing address:
  • Phone: 650-544-9861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: