Provider Demographics
NPI:1093767840
Name:WILL, PATRICIA DIANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:DIANNE
Last Name:WILL
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 1:631 MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864
Mailing Address - Country:US
Mailing Address - Phone:916-487-0590
Mailing Address - Fax:916-487-0591
Practice Address - Street 1:1500 C STREET
Practice Address - Street 2:CAPITAL HEALTH CLINIC
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814
Practice Address - Country:US
Practice Address - Phone:916-874-5303
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A36866Medicare UPIN