Healthcare Provider Details

I. General information

NPI: 1881620953
Provider Name (Legal Business Name): PATRICE T OLOPAI M.A, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICE M TOURNE M.A.

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 HOLLYWOOD BLVD STE 424
HOLLYWOOD FL
33021
US

IV. Provider business mailing address

P.O. BOX 406153
ATLANTA GA
30384-1876
US

V. Phone/Fax

Practice location:
  • Phone: 954-963-6305
  • Fax:
Mailing address:
  • Phone: 954-963-6305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: