Provider Demographics
NPI:1104955533
Name:MAROUDAS, PATRICIA L (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:L
Last Name:MAROUDAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 WAYLAND LN
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4158
Mailing Address - Country:US
Mailing Address - Phone:408-847-8555
Mailing Address - Fax:408-847-6709
Practice Address - Street 1:8010 WAYLAND LN
Practice Address - Street 2:SUITE 1B
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4158
Practice Address - Country:US
Practice Address - Phone:408-847-8555
Practice Address - Fax:408-847-6709
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor