Provider Demographics
NPI:1689970139
Name:COLLINS, PATRICA (CO)
Entity type:Individual
Prefix:
First Name:PATRICA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 HI TECH PKWY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-9372
Mailing Address - Country:US
Mailing Address - Phone:209-845-8231
Mailing Address - Fax:209-845-2883
Practice Address - Street 1:430 40TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2691
Practice Address - Country:US
Practice Address - Phone:510-653-9834
Practice Address - Fax:510-653-9037
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXA0026210Medicaid