Provider Demographics
NPI:1033134861
Name:PATAKI, CAROLY S (MD)
Entity Type:Individual
Prefix:
First Name:CAROLY
Middle Name:S
Last Name:PATAKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CENTRE PLAZA DRIVE
Mailing Address - Street 2:JUVENILE COURT MENTAL HEALTH SERVICE
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754
Mailing Address - Country:US
Mailing Address - Phone:310-344-9065
Mailing Address - Fax:213-268-2525
Practice Address - Street 1:201 CENTRE PLAZA DRIVE
Practice Address - Street 2:JUVENILE COURT MENTAL HEALTH SERVICE
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:90754
Practice Address - Country:US
Practice Address - Phone:310-344-9065
Practice Address - Fax:213-268-2525
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG500662084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G500660OtherMEDI CAL
CAWG50066AMedicare ID - Type Unspecified
CA00G500660OtherMEDI CAL