Healthcare Provider Details

I. General information

NPI: 1811887003
Provider Name (Legal Business Name): PATRICIA MARY MIKULAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA MARY MOORE RN

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

630 N ORANGE GROVE BLVD
PASADENA CA
91103-3315
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5000
  • Fax:
Mailing address:
  • Phone: 818-402-5429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95189728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: