Provider Demographics
NPI:1558488049
Name:WASHINGTON, PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-0476
Mailing Address - Country:US
Mailing Address - Phone:909-592-2346
Mailing Address - Fax:909-592-1896
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE #102
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-706-0678
Practice Address - Fax:949-706-7850
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43579174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A435790OtherBLUE CROSS
CA00A435790Medicaid
CA00A435790Medicaid
CA00A435790Medicaid
CAF34952Medicare UPIN