Provider Demographics
NPI:1003442427
Name:PATEL, AAYESHA ARUN (PA)
Entity Type:Individual
Prefix:
First Name:AAYESHA
Middle Name:ARUN
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 TALCEY TER
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-7519
Mailing Address - Country:US
Mailing Address - Phone:909-851-9489
Mailing Address - Fax:
Practice Address - Street 1:299 W FOOTHILL BLVD STE 209
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3806
Practice Address - Country:US
Practice Address - Phone:909-982-4000
Practice Address - Fax:909-981-7800
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA57503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant