Provider Demographics
NPI:1639419575
Name:PATRICK, TRACY (CLD CPD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:CLD CPD
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 1432
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-4432
Mailing Address - Country:US
Mailing Address - Phone:707-315-5364
Mailing Address - Fax:
Practice Address - Street 1:475 MILLS DR
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-1429
Practice Address - Country:US
Practice Address - Phone:707-315-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula