Provider Demographics
NPI:1871350157
Name:FARIAS, PATRICIA S
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:FARIAS
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 1:8554 ROSEMARY DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-2965
Mailing Address - Country:US
Mailing Address - Phone:909-773-8523
Mailing Address - Fax:
Practice Address - Street 1:8554 ROSEMARY DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-2965
Practice Address - Country:US
Practice Address - Phone:909-773-8523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95105221163WW0101X
CA95012104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory