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General NPI Number Information
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NPI Number | 1295821999
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Entity Type | Individual
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Provider Name | PATRICIA DAUGHERTY DAUGHERTY PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3300 STOCKTON BLVD.
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City | SACRAMENTO
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State | CA
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Zip | 95817
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Country | US
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Telephone | 916-734-8396
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Fax |
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Provider Business Mailing Address
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Address Line | 5601 V ST.
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City | SACRAMENTO
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State | CA
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Zip | 95817
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Country | US
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Telephone | 916-456-1420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12596
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License Number State | CA
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