MEDICARE: DEBRA J. PATRICK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	1818646	CA
2	363AS0400X	Surgical Physician Assistant	18646	CA
3	363A00000X	Physician Assistant	PA00998	TX

General Provider Information

NPI Number	:	1205893195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA J. PATRICK PA-C

Provider Business Mailing Address
First Line	:	34800 BOB WILSON DR STE 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-1003
Country	:	US
Telephone Number	:	619-532-7200
Fax Number	:	619-532-7234

Provider Business Practice Location Address
First Line	:	34800 BOB WILSON DR STE 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-5301
Country	:	US
Telephone Number	:	619-532-7200
Fax Number	:	619-532-7234

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	02/25/2021

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