Basic Information
| Provider Information | |||||||||
| NPI: | 1598996266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAGLE | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2142 OVERLAND AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900256309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107707757 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1145 GAYLEY AVE | ||||||||
| Address2: | SUITE 322 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900243423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102087187 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2009 | ||||||||
| LastUpdateDate: | 07/29/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.