Provider Demographics
NPI:1588257265
Name:PATEL, RADHIKA P
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:P
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 LONG COVE CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-0703
Mailing Address - Country:US
Mailing Address - Phone:951-643-9988
Mailing Address - Fax:
Practice Address - Street 1:3511 MADISON ST STE F
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3739
Practice Address - Country:US
Practice Address - Phone:951-688-7392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-14
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist