Provider Demographics
NPI:1861484685
Name:BREEN-MCDONOUGH, PATRICIA
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:BREEN-MCDONOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 S SUNSET AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3546
Mailing Address - Country:US
Mailing Address - Phone:626-337-7204
Mailing Address - Fax:626-851-1855
Practice Address - Street 1:767 S SUNSET AVE
Practice Address - Street 2:STE 4
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3546
Practice Address - Country:US
Practice Address - Phone:626-337-7204
Practice Address - Fax:626-851-1855
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ26584Medicare UPIN