Provider Demographics
NPI:1275118663
Name:PATIL, MAMTA
Entity Type:Individual
Prefix:
First Name:MAMTA
Middle Name:
Last Name:PATIL
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 1:268 ORANGE BLOSSOM
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4434
Mailing Address - Country:US
Mailing Address - Phone:714-307-4504
Mailing Address - Fax:
Practice Address - Street 1:18922 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1997
Practice Address - Country:US
Practice Address - Phone:657-325-8864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist