MEDICARE: DR. PATRICIA G DITTON PH.D.

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	103T00000X	Psychologist	PSY9483	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376542985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA G DITTON PH.D.

Provider Business Mailing Address
First Line	:	6621 ELVERTON DR
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-1177
Country	:	US
Telephone Number	:	510-339-8458
Fax Number	:	510-339-3902

Provider Business Practice Location Address
First Line	:	2428 DWIGHT WAY
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-3503
Country	:	US
Telephone Number	:	510-339-8458
Fax Number	:	510-339-3902

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/08/2007

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