Provider Demographics
NPI:1003454018
Name:PATEL, MAYURKUMAR (NP-C)
Entity Type:Individual
Prefix:
First Name:MAYURKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5763 STEVENSON BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5301
Mailing Address - Country:US
Mailing Address - Phone:773-793-7933
Mailing Address - Fax:
Practice Address - Street 1:5763 STEVENSON BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5301
Practice Address - Country:US
Practice Address - Phone:510-656-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily