Provider Demographics
NPI:1104817147
Name:PATEL, RENUKA NARAIN (MD)
Entity type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:NARAIN
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 989
Mailing Address - Street 2:
Mailing Address - City:ATWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:92811-0989
Mailing Address - Country:US
Mailing Address - Phone:314-775-3697
Mailing Address - Fax:
Practice Address - Street 1:18837 BROOKHURST ST STE 110
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7301
Practice Address - Country:US
Practice Address - Phone:314-246-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1819732084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E59588Medicare UPIN