Provider Demographics
NPI:1083755862
Name:LOO, PATRICIA K (PA)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:K
Last Name:LOO
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:355 LENNON LN
Mailing Address - Street 2:STE 255
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2496
Mailing Address - Country:US
Mailing Address - Phone:925-932-7704
Mailing Address - Fax:925-932-7752
Practice Address - Street 1:106 LA CASA VIA STE 240
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3012
Practice Address - Country:US
Practice Address - Phone:925-932-7704
Practice Address - Fax:925-932-7752
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA18624363A00000X, 363AS0400X
PA186214363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA186240Medicare PIN