Provider Demographics
NPI:1194297952
Name:PATCHIN, SAMUEL TIMOTHY
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:TIMOTHY
Last Name:PATCHIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RIGG ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4203
Mailing Address - Country:US
Mailing Address - Phone:831-423-3890
Mailing Address - Fax:
Practice Address - Street 1:125 RIGG ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4203
Practice Address - Country:US
Practice Address - Phone:831-423-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator