Provider Demographics
NPI:1013373232
Name:PATEL, CHANDNI (BA)
Entity Type:Individual
Prefix:
First Name:CHANDNI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 4TH ST APT 439
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3642
Mailing Address - Country:US
Mailing Address - Phone:209-670-5343
Mailing Address - Fax:
Practice Address - Street 1:201 S 4TH ST APT 439
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-3642
Practice Address - Country:US
Practice Address - Phone:209-670-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health