Provider Demographics
NPI:1245687359
Name:PATRICIO, AUDREY (ND)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:PATRICIO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 W BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1414
Mailing Address - Country:US
Mailing Address - Phone:818-736-9889
Mailing Address - Fax:800-830-0421
Practice Address - Street 1:1122 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1414
Practice Address - Country:US
Practice Address - Phone:818-736-9889
Practice Address - Fax:800-830-0421
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND705175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath