Provider Demographics
NPI:1659412294
Name:PATTEN, GREGORY H (LPT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:H
Last Name:PATTEN
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S CHAPEL AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4249
Mailing Address - Country:US
Mailing Address - Phone:626-463-1021
Mailing Address - Fax:
Practice Address - Street 1:2550 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3406
Practice Address - Country:US
Practice Address - Phone:626-463-1021
Practice Address - Fax:626-844-0481
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28188167G00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician