Provider Demographics
NPI:1982796165
Name:PATTARA, SANTI (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTI
Middle Name:
Last Name:PATTARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E 4TH ST # 185B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3814
Mailing Address - Country:US
Mailing Address - Phone:714-835-3314
Mailing Address - Fax:714-835-3315
Practice Address - Street 1:2101 E 4TH ST # 185B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3814
Practice Address - Country:US
Practice Address - Phone:714-835-3314
Practice Address - Fax:714-835-3315
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA359832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A359830Medicaid
CAA35983Medicare ID - Type Unspecified
CA00A359830Medicaid