Healthcare Provider Details

I. General information

NPI: 1164043709
Provider Name (Legal Business Name): PAT CARINUGAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 X ST FL 2
SACRAMENTO CA
95817-2229
US

IV. Provider business mailing address

3381 BRIDGEWAY LAKES DR
WEST SACRAMENTO CA
95691-6243
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5959
  • Fax: 916-703-5265
Mailing address:
  • Phone: 410-979-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95013034
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number95013034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: