Healthcare Provider Details

I. General information

NPI: 1982764627
Provider Name (Legal Business Name): PATRICIA LYNNE CARBONE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 VACA VALLEY PKWY
VACAVILLE CA
95688-9430
US

IV. Provider business mailing address

3700 VACA VALLEY PKWY
VACAVILLE CA
95688-9430
US

V. Phone/Fax

Practice location:
  • Phone: 707-453-5173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number493148
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number493148
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number493148
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: