Provider Demographics
NPI:1528809647
Name:PATTON, TENAYA
Entity type:Individual
Prefix:
First Name:TENAYA
Middle Name:
Last Name:PATTON
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 1:720 OLIVE DR STE D1
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4740
Mailing Address - Country:US
Mailing Address - Phone:530-206-3669
Mailing Address - Fax:530-231-2801
Practice Address - Street 1:720 OLIVE DR STE D1
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4740
Practice Address - Country:US
Practice Address - Phone:530-206-3669
Practice Address - Fax:530-231-2801
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT-00021986246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy