Provider Demographics
NPI:1710199989
Name:WYATT, PATRICIA E (REEG EPT, CNIM)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:WYATT
Suffix:
Gender:F
Credentials:REEG EPT, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 SUN CENTER DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6161
Mailing Address - Country:US
Mailing Address - Phone:916-631-0112
Mailing Address - Fax:916-631-1652
Practice Address - Street 1:11121 SUN CENTER DR
Practice Address - Street 2:SUITE G
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-6161
Practice Address - Country:US
Practice Address - Phone:916-631-0112
Practice Address - Fax:916-631-1652
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487247200000X
CA456247200000X
CA22862472E0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Not Answered2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG