Provider Demographics
NPI:1134134786
Name:RAM V PATAK MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RAM V PATAK MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-993-5600
Mailing Address - Street 1:18531 ROSCOE BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4641
Mailing Address - Country:US
Mailing Address - Phone:818-993-5600
Mailing Address - Fax:818-775-1509
Practice Address - Street 1:18531 ROSCOE BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4641
Practice Address - Country:US
Practice Address - Phone:818-993-5600
Practice Address - Fax:818-775-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39711261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0050270Medicaid
CAC35673Medicare UPIN
CAGR0050270Medicaid