Healthcare Provider Details

I. General information

NPI: 1982808234
Provider Name (Legal Business Name): PATRICK JAMES TOMAFSKY PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 CHANTICLEER AVE
SANTA CRUZ CA
95065-1815
US

IV. Provider business mailing address

2350 W EL CAMINO REAL 2ND FLOOR
MOUNTAIN VIEW CA
94040-6203
US

V. Phone/Fax

Practice location:
  • Phone: 831-423-4111
  • Fax:
Mailing address:
  • Phone: 831-423-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTMA051734
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: