Healthcare Provider Details

I. General information

NPI: 1164897237
Provider Name (Legal Business Name): PATRICIA CELIA MCCORMICK B.C.J.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MOORPARK AVE SUITE 300
SAN JOSE CA
95128-2631
US

IV. Provider business mailing address

2400 MOORPARK AVE SUITE 300
SAN JOSE CA
95128-2631
US

V. Phone/Fax

Practice location:
  • Phone: 408-975-2730
  • Fax:
Mailing address:
  • Phone: 408-975-2730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number7050860
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: