Provider Demographics
NPI:1043029770
Name:PATTERSON, OPAL S (LVN)
Entity type:Individual
Prefix:
First Name:OPAL
Middle Name:S
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 METROPOLITAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4402
Mailing Address - Country:US
Mailing Address - Phone:619-966-3352
Mailing Address - Fax:
Practice Address - Street 1:7545 METROPOLITAN DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4402
Practice Address - Country:US
Practice Address - Phone:619-966-3352
Practice Address - Fax:619-718-9897
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA725211164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty