Provider Demographics
NPI:1235876673
Name:PATEL, DEENAZ BURJOR
Entity Type:Individual
Prefix:
First Name:DEENAZ
Middle Name:BURJOR
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 1:9180 W SAINT JOHN RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7727
Mailing Address - Country:US
Mailing Address - Phone:602-877-3330
Mailing Address - Fax:
Practice Address - Street 1:9180 W SAINT JOHN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7727
Practice Address - Country:US
Practice Address - Phone:602-877-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical