Provider Demographics
NPI:1073892212
Name:PATEL, AMI JINESH (PA)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:JINESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:DILIP
Other - Last Name:TRIVEDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 SAINT CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-8245
Mailing Address - Country:US
Mailing Address - Phone:909-794-3735
Mailing Address - Fax:
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335
Practice Address - Country:US
Practice Address - Phone:909-427-7242
Practice Address - Fax:909-427-4620
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002867363A00000X
NY011008363A00000X
CAPA19824363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant