Healthcare Provider Details

I. General information

NPI: 1437212461
Provider Name (Legal Business Name): VANESSA PATRICK P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W SYCAMORE ST
WILLOWS CA
95988-2832
US

IV. Provider business mailing address

460 W SYCAMORE ST
WILLOWS CA
95988-2832
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-3385
  • Fax: 530-934-3387
Mailing address:
  • Phone: 530-934-3385
  • Fax: 530-934-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13210
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA13210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: