Provider Demographics
NPI:1154014330
Name:PATIL, SANJAY R
Entity type:Individual
Prefix:
First Name:SANJAY
Middle Name:R
Last Name:PATIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4244 ASTOR HOLLOW ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4877
Mailing Address - Country:US
Mailing Address - Phone:925-876-6900
Mailing Address - Fax:
Practice Address - Street 1:4244 ASTOR HOLLOW ST
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4877
Practice Address - Country:US
Practice Address - Phone:925-876-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist