Healthcare Provider Details

I. General information

NPI: 1316567357
Provider Name (Legal Business Name): PATRICK FEDDOR TOMASINO-GRIEGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PATRICK GRIEGO

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SNEATH LN STE 200
SAN BRUNO CA
94066-2349
US

IV. Provider business mailing address

1460 18TH AVE
SAN FRANCISCO CA
94122-3409
US

V. Phone/Fax

Practice location:
  • Phone: 916-382-4447
  • Fax:
Mailing address:
  • Phone: 404-205-8023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: