Organization
BLUE LOTUS CONNECTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICE FORTUNE MA, MS, LMFT, ATR (FOUNDER/OWNER)
(650) 619-9942
Entity
Organization
Contact information
Practice address
1700 S AMPHLETT BLVD, STE 250B, SAN MATEO, CA 94402
(650) 619-9942
Mailing address
63 BOVET ROAD #221, SAN MATEO, CA 94402
(650) 619-9942
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235368135
—
CA
Enumeration date
12/11/2017
Last updated
12/11/2017
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