1336572247 NPI number — GITA J. PATEL, DPM, INC.

Table of content: (NPI 1336572247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336572247 NPI number — GITA J. PATEL, DPM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GITA J. PATEL, DPM, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1336572247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2340 ALMOND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94520-2026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-827-4056
Provider Business Mailing Address Fax Number:
925-407-8352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1479 YGNACIO VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598-2986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-765-9719
Provider Business Practice Location Address Fax Number:
925-407-8352
Provider Enumeration Date:
08/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
GITANJALI
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
925-827-4056

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  E4559 , 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)

  • Identifier: 000E45591 . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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