MEDICARE: MRS. PATRICIA COAUETTE RDH, RDHAP

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	124Q00000X	Dental Hygienist	HAP 420	CA

General Provider Information

NPI Number	:	1477805257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA COAUETTE RDH, RDHAP

Provider Business Mailing Address
First Line	:	7698 CALLAWAY DR.
Second Line	:
City	:	RANCHO MURIETA
State	:	CA
Zip	:	95683-9268
Country	:	US
Telephone Number	:	916-601-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	7698 CALLAWAY DR
Second Line	:
City	:	RANCHO MURIETA
State	:	CA
Zip	:	95683-9268
Country	:	US
Telephone Number	:	916-601-8400
Fax Number	:

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

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	10/04/2012

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