Healthcare Provider Details

I. General information

NPI: 1710283858
Provider Name (Legal Business Name): ROBERT PATTERSON CO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 FOREST AVE SUITE 3
SAN JOSE CA
95128-1478
US

IV. Provider business mailing address

2120 FOREST AVE SUITE 3
SAN JOSE CA
95128-1478
US

V. Phone/Fax

Practice location:
  • Phone: 408-217-9387
  • Fax: 408-564-0138
Mailing address:
  • Phone: 408-217-9387
  • Fax: 408-564-0138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCO001238
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: