Provider Demographics
NPI:1215302294
Name:PATEL, NIRALI (LAC)
Entity type:Individual
Prefix:
First Name:NIRALI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 SAN ANSELMO AVE S
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-5312
Mailing Address - Country:US
Mailing Address - Phone:206-330-1548
Mailing Address - Fax:
Practice Address - Street 1:1098 FOSTER CITY BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2345
Practice Address - Country:US
Practice Address - Phone:650-667-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16883171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist