Provider Demographics
NPI:1710283858
Name:PATTERSON, ROBERT (CO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 FOREST AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1478
Mailing Address - Country:US
Mailing Address - Phone:408-217-9387
Mailing Address - Fax:408-564-0138
Practice Address - Street 1:2120 FOREST AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1478
Practice Address - Country:US
Practice Address - Phone:408-217-9387
Practice Address - Fax:408-564-0138
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246Z00000X, 225000000X
CACO001238222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXA0012380Medicaid