Provider Demographics
NPI:1932511904
Name:PATEL, NIKITA MOHAN (MD)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:MOHAN
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 1:1655 DALIDIO DR UNIT 3151
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-7007
Mailing Address - Country:US
Mailing Address - Phone:805-316-0698
Mailing Address - Fax:
Practice Address - Street 1:1655 DALIDIO DR UNIT 3151
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93403-7007
Practice Address - Country:US
Practice Address - Phone:805-316-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143360207R00000X, 207RG0300X, 207RR0500X
CO60871207R00000X, 207RG0300X
NMMD2019-0933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine