Provider Demographics
NPI:1164452322
Name:DR DINETH KANTILAL PATEL MD A CALIFORNIA MEDICAL COPRPORATION
Entity Type:Organization
Organization Name:DR DINETH KANTILAL PATEL MD A CALIFORNIA MEDICAL COPRPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:KANTILAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-378-7010
Mailing Address - Street 1:9900 TALBERT AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-378-7010
Mailing Address - Fax:714-378-5504
Practice Address - Street 1:9900 TALBERT AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-378-7010
Practice Address - Fax:714-378-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67079207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A489750Medicaid
CA00A489750Medicaid
CAF90566Medicare UPIN