Provider Demographics
NPI:1194958256
Name:PATEL, REENA R (MD)
Entity type:Individual
Prefix:DR
First Name:REENA
Middle Name:R
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 1:1730 HUNTINGTON DR STE 203
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4860
Mailing Address - Country:US
Mailing Address - Phone:626-765-7852
Mailing Address - Fax:626-606-3952
Practice Address - Street 1:1730 HUNTINGTON DR STE 203
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4860
Practice Address - Country:US
Practice Address - Phone:626-765-7852
Practice Address - Fax:626-606-3952
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 109224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A252740Medicaid
CAEA353YMedicare PIN