Basic Information
| Provider Information | |||||||||
| NPI: | 1053504472 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGREDANO | ||||||||
| FirstName: | PATRICE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1451 ROCKY RIDGE DR APT 1109 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956613007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163202503 | ||||||||
| FaxNumber: | 9162838259 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 I ST | ||||||||
| Address2: | |||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956164213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306015959 | ||||||||
| FaxNumber: | 9162874679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 08/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 102263 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.