Provider Demographics
NPI:1356301675
Name:FERRARO, PATRICIA L (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:L
Last Name:FERRARO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 BARTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-3411
Mailing Address - Country:US
Mailing Address - Phone:530-541-2665
Mailing Address - Fax:530-541-2615
Practice Address - Street 1:2229 BARTON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3411
Practice Address - Country:US
Practice Address - Phone:530-541-2665
Practice Address - Fax:530-541-2615
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9201213E00000X
CAE3664213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1041920001Medicare NSC
CAGU504ZMedicare PIN
CAU09127Medicare UPIN
CA000E36640Medicare PIN
CA480012585Medicare PIN