Healthcare Provider Details

I. General information

NPI: 1730041468
Provider Name (Legal Business Name): ZACHARY PATTERSON BSN, RN, PHN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 E LUGONIA AVE # 117-17
REDLANDS CA
92374-2730
US

IV. Provider business mailing address

1752 E LUGONIA AVE # 117-17
REDLANDS CA
92374-2730
US

V. Phone/Fax

Practice location:
  • Phone: 909-213-9488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number95288387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: