Healthcare Provider Details

I. General information

NPI: 1972556751
Provider Name (Legal Business Name): BRENDA FAYE PATRICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13851 E 14TH ST SUITE 206
SAN LEANDRO CA
94578-2631
US

IV. Provider business mailing address

13851 E 14TH ST SUITE 206
SAN LEANDRO CA
94578-2631
US

V. Phone/Fax

Practice location:
  • Phone: 510-351-9373
  • Fax: 510-351-7026
Mailing address:
  • Phone: 510-351-9373
  • Fax: 510-351-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number271955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: