Provider Demographics
NPI:1871611384
Name:ADAMS, PATRICIA (RN/CDE)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RN/CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 SOQUEL AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:815 BAY AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2186
Practice Address - Country:US
Practice Address - Phone:831-460-7333
Practice Address - Fax:831-458-6999
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20210520133NN1002X
CA343869163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education