Provider Demographics
NPI:1548278559
Name:PATHARE, JODY ROBEN (NP)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:ROBEN
Last Name:PATHARE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:ROBEN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 W LA VETA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4213
Mailing Address - Country:US
Mailing Address - Phone:714-633-0942
Mailing Address - Fax:714-633-7110
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:NEUROSCIENCE INSTITUTE 5TH FLOOR
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3835
Practice Address - Country:US
Practice Address - Phone:714-289-4151
Practice Address - Fax:714-997-3758
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16259363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner