Provider Demographics
NPI:1194924829
Name:PAINE, PATRICK TREAT (LAC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:TREAT
Last Name:PAINE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3916
Mailing Address - Country:US
Mailing Address - Phone:805-541-1980
Mailing Address - Fax:805-541-1980
Practice Address - Street 1:1318 GARDEN ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3916
Practice Address - Country:US
Practice Address - Phone:805-541-1980
Practice Address - Fax:805-541-1980
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9944171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist