Provider Demographics
NPI:1063662096
Name:MYERS, PATTRICIA K
Entity Type:Individual
Prefix:
First Name:PATTRICIA
Middle Name:K
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E FREDRICKS ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2822
Mailing Address - Country:US
Mailing Address - Phone:760-255-1083
Mailing Address - Fax:760-255-1383
Practice Address - Street 1:308 E FREDRICKS ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2822
Practice Address - Country:US
Practice Address - Phone:760-255-1083
Practice Address - Fax:760-255-1383
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker