Provider Demographics
NPI:1467468306
Name:ANDERSON, PATRICIA G (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:G
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 MEDICAL CENTER CT
Mailing Address - Street 2:STE. 6
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6634
Mailing Address - Country:US
Mailing Address - Phone:619-656-1010
Mailing Address - Fax:619-656-1084
Practice Address - Street 1:750 MEDICAL CENTER CT
Practice Address - Street 2:STE. 12
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6634
Practice Address - Country:US
Practice Address - Phone:619-656-2971
Practice Address - Fax:619-656-2981
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA486212084N0400X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE79862Medicare UPIN