Provider Demographics
NPI:1316567357
Name:TOMASINO-GRIEGO, PATRICK FEDDOR
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:FEDDOR
Last Name:TOMASINO-GRIEGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:
Other - Last Name:GRIEGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1460 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3409
Mailing Address - Country:US
Mailing Address - Phone:404-205-8023
Mailing Address - Fax:
Practice Address - Street 1:1001 SNEATH LN STE 200
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2349
Practice Address - Country:US
Practice Address - Phone:916-382-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician