1558488049 NPI number — PATRICIA WASHINGTON M.D.

Table of content: PATRICIA WASHINGTON M.D. (NPI 1558488049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558488049 NPI number — PATRICIA WASHINGTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASHINGTON
Provider First Name:
PATRICIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558488049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 476
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIMAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91773-0476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-592-2346
Provider Business Mailing Address Fax Number:
909-592-1896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 NEWPORT CENTER DR
Provider Second Line Business Practice Location Address:
SUITE #102
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92660-7601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-706-0678
Provider Business Practice Location Address Fax Number:
949-706-7850
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A43579 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A435790 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A435790 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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