Provider Demographics
NPI:1588701064
Name:PATEL, RAJESH (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAJESHKUMAR
Other - Middle Name:RAMANLAL
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:268 W HOSPITALITY LN
Mailing Address - Street 2:STE. 400
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0001
Mailing Address - Country:US
Mailing Address - Phone:909-382-3087
Mailing Address - Fax:909-382-3106
Practice Address - Street 1:268 W HOSPITALITY LN
Practice Address - Street 2:STE. 400
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0001
Practice Address - Country:US
Practice Address - Phone:909-382-3087
Practice Address - Fax:909-382-3106
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA459832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45983OtherMEDICAL LICENSE NUMBER
CAE73583Medicare UPIN