Provider Demographics
NPI:1841376738
Name:PATEL, MAHENDRA SOMABHAI (MD)
Entity type:Individual
Prefix:DR
First Name:MAHENDRA
Middle Name:SOMABHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5451 LA PALMA AVE
Mailing Address - Street 2:SUITE # 15
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1728
Mailing Address - Country:US
Mailing Address - Phone:714-994-1401
Mailing Address - Fax:714-994-2810
Practice Address - Street 1:5451 LA PALMA AVE
Practice Address - Street 2:SUITE # 15
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1728
Practice Address - Country:US
Practice Address - Phone:714-994-1401
Practice Address - Fax:714-994-2810
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA38027207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA03802700Medicaid
CAA03802700Medicaid
CAA85090Medicare UPIN