Healthcare Provider Details

I. General information

NPI: 1063472512
Provider Name (Legal Business Name): PATRICIA LYNN OBRIEN REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER 0102
SACRAMENTO CA
95817
US

IV. Provider business mailing address

2315 STOCKTON BLVD UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER 0102
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-4742
  • Fax: 916-734-0635
Mailing address:
  • Phone: 916-734-4742
  • Fax: 916-734-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: