Provider Demographics
NPI:1235443698
Name:PATEL, KRUTI KIRIT
Entity Type:Individual
Prefix:
First Name:KRUTI
Middle Name:KIRIT
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 C ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5100
Mailing Address - Country:US
Mailing Address - Phone:619-233-1666
Mailing Address - Fax:619-233-3724
Practice Address - Street 1:427 C ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5100
Practice Address - Country:US
Practice Address - Phone:619-233-1666
Practice Address - Fax:619-233-3724
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist