Provider Demographics
NPI:1346401163
Name:PATINO, AURORA
Entity Type:Individual
Prefix:
First Name:AURORA
Middle Name:
Last Name:PATINO
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 1:1160 W YOSEMITE AVE
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-5239
Mailing Address - Country:US
Mailing Address - Phone:209-624-5172
Mailing Address - Fax:209-624-5179
Practice Address - Street 1:1160 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5239
Practice Address - Country:US
Practice Address - Phone:209-624-5172
Practice Address - Fax:209-624-5179
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics