Provider Demographics
NPI:1558021097
Name:PATA, LUKE (PA-C)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:PATA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19245 SLATE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4310
Mailing Address - Country:US
Mailing Address - Phone:626-642-6134
Mailing Address - Fax:
Practice Address - Street 1:19245 SLATE CREEK DR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4310
Practice Address - Country:US
Practice Address - Phone:626-642-6134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-25
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant