Provider Demographics
NPI:1073644100
Name:DEVESH N PATEL,MD
Entity Type:Organization
Organization Name:DEVESH N PATEL,MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVESH
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-914-1514
Mailing Address - Street 1:2694 E GARVEY AVE S
Mailing Address - Street 2:# 395
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-2113
Mailing Address - Country:US
Mailing Address - Phone:626-914-1514
Mailing Address - Fax:626-914-1505
Practice Address - Street 1:130 W ROUTE 66
Practice Address - Street 2:SUITE 302
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6249
Practice Address - Country:US
Practice Address - Phone:626-914-1514
Practice Address - Fax:626-914-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A893300OtherMEDI-CAL
CA00A893300OtherMEDI-CAL
CAI43815Medicare UPIN