Healthcare Provider Details

I. General information

NPI: 1396778833
Provider Name (Legal Business Name): PATRICE VILLARS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4150 CLEMENT ST NH - 181
SAN FRANCISCO CA
94121-1545
US

IV. Provider business mailing address

850 IDYLBERRY RD
SAN RAFAEL CA
94903-1236
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax:
Mailing address:
  • Phone: 415-499-8179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number517530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: