1740362490 NPI number — RAJAN PRAVIN PATEL MD

Table of content: RAJAN PRAVIN PATEL MD (NPI 1740362490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740362490 NPI number — RAJAN PRAVIN PATEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
RAJAN
Provider Middle Name:
PRAVIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740362490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1098 FOSTER CITY BLVD STE 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOSTER CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94404-2375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-474-2130
Provider Business Mailing Address Fax Number:
833-499-1785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5050 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
LOS ALTOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-964-6700
Provider Business Practice Location Address Fax Number:
650-964-3495
Provider Enumeration Date:
10/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G71817 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)