1376593657 NPI number — DR. GNYANDEV PATEL M.D.

Table of content: DR. GNYANDEV PATEL M.D. (NPI 1376593657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376593657 NPI number — DR. GNYANDEV PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
GNYANDEV
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1376593657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLFLOWER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90707-0189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-232-2378
Provider Business Mailing Address Fax Number:
562-232-2379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 E SOUTH ST
Provider Second Line Business Practice Location Address:
SUITE # 206
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90805-4549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-232-2378
Provider Business Practice Location Address Fax Number:
562-232-2379
Provider Enumeration Date:
05/10/2006

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: 174400000X , with the licence number:  A618690 , 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: 200059993 . This is a "E.I.N NO." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A618690 . This is a "B/C PROVIDER NO." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A618690 . This is a "B/S PROVIDER NO." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A618690 . This is a "STATE LICENSE NO." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 109489300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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