Provider Demographics
NPI:1275950222
Name:PATEL, VIJITA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJITA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 674057
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4057
Mailing Address - Country:US
Mailing Address - Phone:915-455-2266
Mailing Address - Fax:817-887-5350
Practice Address - Street 1:1395 GEORGE DIETER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7499
Practice Address - Country:US
Practice Address - Phone:915-455-2266
Practice Address - Fax:817-887-5350
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR6072208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program