Provider Demographics
NPI:1053688945
Name:YOGENDRA B PATEL,MD,INC
Entity Type:Organization
Organization Name:YOGENDRA B PATEL,MD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-924-9300
Mailing Address - Street 1:12980 FREDERICK ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5263
Mailing Address - Country:US
Mailing Address - Phone:951-924-9300
Mailing Address - Fax:951-485-0240
Practice Address - Street 1:12980 FREDERICK ST
Practice Address - Street 2:SUITE J
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5263
Practice Address - Country:US
Practice Address - Phone:951-924-9300
Practice Address - Fax:951-485-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40908207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1386706240OtherINDIVIDUAL EXISTING NPI
CA00A409080Medicaid
CA00A409080Medicaid
CA00A409080Medicare PIN