Provider Demographics
NPI:1528686284
Name:PATTERSON, PAMELA (CNA, CHHA)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:CNA, CHHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31712 VIA ANA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3029
Mailing Address - Country:US
Mailing Address - Phone:949-690-3011
Mailing Address - Fax:
Practice Address - Street 1:31712 VIA ANA
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3029
Practice Address - Country:US
Practice Address - Phone:949-690-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01146589374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide