Provider Demographics
NPI:1114763539
Name:PATTERSON, CHARLES AIDAN MCBRUCE (CSCS)
Entity type:Individual
Prefix:
First Name:CHARLES AIDAN
Middle Name:MCBRUCE
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 CHAPMAN ST APT 121
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5653
Mailing Address - Country:US
Mailing Address - Phone:650-417-5991
Mailing Address - Fax:
Practice Address - Street 1:3910 CHAPMAN ST APT 121
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5653
Practice Address - Country:US
Practice Address - Phone:650-417-5991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer